Narihiro Satoshi, Yoshida Masashi, Ohdaira Hironori, Takeuchi Hideyuki, Kamada Teppei, Marukuchi Rui, Suzuki Norihiko, Hoshimoto Sojun, Sato Takayuki, Suzuki Yutaka
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan.
Center for Photodynamic Medicine, Kochi University, Kohasu Oko-cho 185-1, Nankoku, Kochi, 783-8505, Japan.
Ann Med Surg (Lond). 2020 May 11;55:49-52. doi: 10.1016/j.amsu.2020.04.026. eCollection 2020 Jul.
This is the first report on near-infrared fluorescent (NIRF) clip-guided gastrectomy. The NIRF clip, ZEOCLIP FS, emits NIRF signals when excited. We hypothesized that preoperative placement of the ZEOCLIP FS near a gastric lesion would allow fluorescence laparoscopic localization of the clip, and hence, the lesion, during surgery. We report this technique in two cases.
Case 1: An 81-year-old female was diagnosed with early gastric cancer and a pedunculated 4 cm large hyperplastic polyp that had prolapsed into the duodenum, and was scheduled for laparoscopy-assisted distal gastrectomy, due to the potential risk of dissection of the polyp with the duodenal wall. On the day before surgery, ZEOCLIP FS clips were endoscopically placed at the cancer site and the polyp. The locations of the fluorescent clips were confirmed intraoperatively using a full-color fluorescence laparoscope.
CASE 2: An 81-year-old male was scheduled for laparoscopy-assisted total gastrectomy for gastric cancer under fluorescent clip-guidance. Clip locations could not be confirmed during initial intraoperative observation. However, when the stomach wall was raised using forceps during a second observation attempt, the fluorescent clip locations were confirmed.
In case 1, it was easy to confirm clip location, facilitating complete resection of early gastric cancer without dissecting the polyp. In case 2, the fluorescent clip was located by raising the stomach and adjusting the angle between the stomach wall and the fluorescence laparoscope.
The positive results of these two cases warrant conducting feasibility studies for use of this method.
这是关于近红外荧光（NIRF）夹子引导下胃切除术的首份报告。NIRF夹子ZEOCLIP FS在受到激发时会发出NIRF信号。我们假设在胃病变附近术前放置ZEOCLIP FS夹子，可使荧光腹腔镜在手术过程中定位夹子，进而定位病变。我们报告两例该技术应用情况。
病例1：一名81岁女性被诊断为早期胃癌，有一个4厘米大的带蒂增生性息肉已脱垂至十二指肠，因息肉与十二指肠壁剥离存在潜在风险，计划行腹腔镜辅助远端胃切除术。手术前一天，通过内镜将ZEOCLIP FS夹子放置在癌灶和息肉处。术中使用全彩色荧光腹腔镜确认了荧光夹子的位置。
病例2：一名81岁男性计划在荧光夹子引导下行腹腔镜辅助全胃切除术治疗胃癌。初次术中观察时无法确认夹子位置。然而，在第二次观察尝试中用镊子提起胃壁时，确认了荧光夹子的位置。
在病例1中，很容易确认夹子位置，便于在不剥离息肉的情况下完整切除早期胃癌。在病例2中，通过提起胃并调整胃壁与荧光腹腔镜之间的角度确定了荧光夹子的位置。
这两例的阳性结果证明有必要对该方法的应用开展可行性研究。
