Summary

胃镜检查术在腹腔镜手术的肿瘤定位于胃腺癌

Published: August 09, 2016
doi:

Summary

In early gastric cancer, the aim of surgery is to precisely remove the distal stomach including the primary tumor. To do this, accurate localization of the tumor is crucial, especially in totally laparoscopic surgery. This protocol describes a procedure for intraoperative gastroscopy in totally laparoscopic subtotal gastrectomy.

Abstract

确定切缘胃癌,其不暴露于胃的浆膜面,是完全的腹腔镜胃切除(TLG)中的最重要的过程。此协议的目的是介绍一个程序,术中胃镜,要想在胃的中间三分之一TLG过程中直接​​标记肿瘤胃癌。谁在胃的中间三分之一诊断为腺癌的患者在这种情况下系列的患者。手术前,不进行对肿瘤的定位额外胃镜。在全身麻醉下,胃的腹腔镜动员首先执行。后十二指肠的第一部分从胰腺动员并夹紧,外科医生移动到另一侧的胃镜过程。在胃镜的通过口腔进入胃的插入,2 – 3立方厘米靛蓝胭脂红的经由内窥镜注射器施用到胃亩在胃的近端缘SCLE层。在腹腔镜下视图染色浆膜的位置是用来指导远端胃大部切除术,但是,如果肿瘤太靠近胃食管结合进行全胃切除。远端胃切除术后的样品进行采样,确认从切缘肿瘤改造前有足够的长度。在我们的案例系列中,所有患者无瘤利润率,不需要额外的手术。没有涉及到胃镜程序发病率,并为过程具有逐渐下降至约五分钟的时间。对于肿瘤定位术胃镜检查是完全接受腹腔镜胃切除远端胃癌患者准确和耐受性的方法。

Introduction

腹腔镜手术已成为东亚国家,包括韩国,日本早期胃癌治疗的选择。1这种手术的优点已为早期胃癌(EGC)几个临床试验已得到充分证明。2-4大多数在这些试验的过程中通过腹腔镜完成,但在肿瘤部位的鉴定,通过小切口进行胃,包括原发肿瘤和重建术。因此,需要手术小切口打出了“腹腔镜辅助胃切除术”。

然而,最近的外科手术已经发展到最小创伤,改善患者生活术后质量。由于这一概念也得到了腹腔镜手术治疗胃癌的应用,一些有经验的医生的腹腔镜曾试图避免小切口。完全腹腔镜下胃大部切除术(TLG)为gastriç癌症要求所有的程序只使用腹腔镜设备完成后,无需对标本切除吻合的额外小切口。由于痛苦少和恢复速度相对这类手术的结果打开或腹腔镜辅助手术,这需要剖腹探查,医生更喜欢它。但5,6,阻碍TLG胃癌是肿瘤的定位没有直接的可视化触诊或以确定胃切除的面积。

肿瘤缺席的切缘是很重要的,以实现胃癌手术的成功。如果肿瘤累及在胃癌远端胃切除术在切除边缘,需要额外的手术切除,以免留下肿瘤在余下的胃。在开放和腹腔镜辅助的手术,原发肿瘤可以容易地通过触诊或直接可视化通过一个临时胃本地化。但是,由于表面RY肿瘤没有在腹腔镜视图容易地检测,确定切缘为EGC在TLG可能很困难。

几个需要额外的术前胃镜确定切缘的其它方法已经被提出。7-9然而,更多的术前胃镜可能是不方便的患者。我们推出了一个程序,术中胃镜TLG期间直接标记肿瘤在胃的中间三分之一胃癌。

在这个协议中,我们采用患者在术前研究早期胃癌,这是不包括在内镜黏膜下剥离术绝对指征的腹腔镜手术。

Protocol

伦理学声明:此过程涉及人类受试者曾在亚洲大学医院批准了机构审查委员会(IRB)。 1.准备手术允许软食手术的前一天,什么也没有用嘴巴午夜后在手术前。 注:前和手术过程中不要插入鼻饲管。该协议不使用任何管放气的肚子。替代的是,在胃内气体可通过腹腔镜穿刺针,如果胃鼓起导致腹腔镜手术有限视图吸出。 把病人躺在手术台上后,管理代理?…

Representative Results

20例患者谁接受胃镜检查术中,18行远端胃大部切除术,在通过胃镜发现指导。但是,我们对两名患者进行全胃切除术,因为近端肿瘤边缘过于接近胃食管结合,如术中胃镜检查确定。从肿瘤到近端切除边缘的距离为3.5厘米,2.5厘米这两个患者中,分别为( 表1)。 总的平均手术时间为远端胃切除术为188分钟。的?…

Discussion

在这个协议中,我们介绍了一个程序,胃镜检查术准确,可靠地识别在胃中的中间三分之一肿瘤的位置。我们能够成功地执行根据术胃镜检查的结果远端胃大部切除术。

迄今为止,各种方法已经被应用,以确定在腹腔镜视图早期胃癌的位置。最常用的方法术前用胃镜的剪裁,和外科医生可以检测到使用腹腔镜超声或便携式X线平片剪辑的位置。7,9术前术前额外胃镜一?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health & Welfare, Republic of Korea (1320270).

Materials

Pentothal Sodium JW pharmatheutical Co. 644912100 It was used as induction asgent
Rocumeron  Ilsung pharmatheutical Co. 655402960 It was used for general anesthestia as muscle relaxant.
SevoFRAN Hana pharmatheutical Co. 657801060 It was used as general anesthetics
Endoscopy system Olympus Corp. CLV-260 It was used for intraoperative GFS
Laparoscopic surgery system Striker Endoscopy 1488 HD 3-CHIP It was a system for laparoscopic surgery
Ultrasonic scissor Johnson and Johnson Medical Corp. HAR23 It was used during tissue dissection
Laparoscopic clip Johnson and Johnson Medical Corp. ER420 It was used for ligation of the vessels.
Indigo carmine Korea United Pharma Carmine It was injected into the gastric wall
Linear stapler Johnson and Johnson Medical Corp. ECHELON FLEX Powered Endopath Stapler It was used for resection the stomach
Gastroscopic injector TaeWoong Medical Cobra injector I was used for gastroscopic injection of blue dye

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Cite This Article
Hur, H., Son, S., Cho, Y. K., Han, S. Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma. J. Vis. Exp. (114), e53170, doi:10.3791/53170 (2016).

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