Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan.
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara City, Tochigi, 329-2763, Japan.
Int J Surg. 2020 Aug;80:74-78. doi: 10.1016/j.ijsu.2020.06.014. Epub 2020 Jun 27.
In colorectal laparoscopic surgery, accuracy of tumor marking has been an important but not fully resolved issue. The tattoo marking technique or intraoperative endoscopy have been used but they either carry the risk of accidental intestinal puncture or require either longer operation times, a skilled endoscopist and/or intraoperative colon insufflation. We supposed that tumor site marking with the near-infrared fluorescent clips, ZEOCLIP FS clips (Zeon Medical Co., Ltd., Tokyo, Japan) might overcome disadvantages of both tattoo marking and intraoperative endoscopy-based tumor localization methods. This is the first report on the case series using near-infrared fluorescent marking clip. We summarize the early results in 30 patients, who underwent colorectal laparoscopic surgery; we focus particularly on effectiveness and safety of the method.
Thirty consecutive patients, who underwent laparoscopic surgery for colorectal cancer after previous endoscopic ZEOCLIP FS placement were enrolled from May 2019 till October 2019. The primary endpoint was the rate of intraoperative clip detection and the secondary endpoints were: the rate of adverse effects, percentage of slipped clips and usefulness of plain abdominal radiography to preoperatively confirm the clip retention. Locations of fluorescent clips were identified with a full-color fluorescence laparoscope. All operations and clip placements were performed by the same senior surgeon with sufficient experience in both procedures.
Fluorescent clips could be detected in 94.1% of tumor lesions. Three (2.1%) clips dropped before surgery. Plain abdominal radiography was sufficient to assess clip retention in all cases. No adverse effects related to either clip placement or clip detection were observed.
The ZEOCLIP FS could be easily detected from the serosal side of the intestinal tract when placed 1-2 days before surgery. Fluorescent clip-guided laparoscopy may be considered a safe and effective method for localization of colorectal tumor sites. The Research Registry UIN: researchregistry5400.
在结直肠腹腔镜手术中，肿瘤标记的准确性一直是一个重要但尚未完全解决的问题。纹身标记技术或术中内镜检查已被应用，但它们要么存在肠穿孔的风险，要么需要更长的手术时间、熟练的内镜医师和/或术中结肠充气。我们假设使用近红外荧光夹（Zeon Medical Co.， Ltd.，东京，日本的 ZEOCLIP FS 夹）进行肿瘤部位标记可能会克服纹身标记和基于术中内镜的肿瘤定位方法的缺点。这是首例使用近红外荧光标记夹的病例系列报告。我们总结了 30 例接受结直肠腹腔镜手术的患者的早期结果，特别关注该方法的有效性和安全性。
2019 年 5 月至 2019 年 10 月，连续 30 例接受腹腔镜结直肠癌手术的患者接受了 ZEOCLIP FS 内镜放置后的近红外荧光夹。主要终点是术中夹检测率，次要终点是：不良事件发生率、夹滑落率和术前普通腹部 X 线片确认夹保留的有用性。使用全彩荧光腹腔镜识别荧光夹的位置。所有手术和夹放置均由具有丰富经验的同一位高级外科医生进行。
94.1%的肿瘤病变可检测到荧光夹。有 3 个（2.1%）夹在手术前脱落。所有病例均通过普通腹部 X 线片足以评估夹保留情况。未观察到与夹放置或夹检测相关的任何不良影响。
ZEOCLIP FS 可在手术前 1-2 天轻松从肠浆膜侧检测到。荧光夹引导下的腹腔镜检查可能是一种安全有效的结直肠肿瘤部位定位方法。研究注册 UIN：researchregistry5400。
