腹腔镜-内镜联合局部胃切除治疗早期胃癌  

Combined laparoscopy-endoscopy local resection for early gastric cancer

作　　者：朱纯超[1] 赵刚[1] Zhu Chunchao;Zhao Gang(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《中华胃肠外科杂志》2020年第10期939-943,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(81802313);上海市教育委员会高峰高原建设计划(20191905)。

摘　　要：早期胃癌的手术治疗正经历着微创化、精准化、个体化的发展,从单纯强调根治到根治与功能保留并重的理念方向改变。腹腔镜-内镜联合局部胃切除手术可以做到早期胃癌病灶精准切除,因为相对于内镜黏膜下剥离术(ESD),内镜下胃壁的全层切除保障了肿瘤的垂直切缘的可靠性,而腹腔镜技术不但可以起到辅助内镜下进行全层切除,缝合胃壁缺损,更解决了ESD所欠缺的淋巴结清扫问题。目前,腹腔镜-内镜联合局部胃切除手术有腹腔镜辅助的内镜下全层切除、内镜辅助的腹腔镜楔形切除术、非暴露技术腹腔镜-内镜联合入路肿瘤切除术和非暴露内镜下胃壁翻转术等。尽管每种双镜联合的治疗方法都存在缺陷,但是相较传统胃切除手术,具有创伤小、手术时间较短、术中出血较少等特点。淋巴结清扫问题是早期胃癌腹腔镜-内镜联合局部胃切除手术的另一个重要问题,然而,现阶段的前哨淋巴结可能仍然存在术中淋巴结示踪操作略显繁琐的问题,并存在一定失败率,而且术中淋巴结活检存在一定比例的假阴性率等因素,限制了其在早期胃癌手术治疗的临床应用。但作为一种发展中的早期胃癌精准治疗手段,相信器械设备技术的发展会使腹腔镜-内镜联合局部胃切除手术方法操作性更强,其应用前景值得期待。The surgical treatment of early gastric cancer(EGC)is undergoing the development of minimally invasive,precise and individualized treatment.The concept is changing from simple emphasis on radical treatment to giving consideration to both radical treatment and functional preservation.Combined laparoscopy-endoscopy local resection can achieve accurate resection of the lesions of EGC and solve the problem of lymph node dissection which cannot be performed in endoscopic mucosal dissection(ESD).At present,there are several methods of combined laparoscopy-endoscopy local resection for EGC,such as laparoscopy-assisted endoscopic full-thickness resection(EFTR),endoscopy-assisted wedge resection(EAWR),combined laparoscopic and endoscopic approach for neoplasia with a non-exposure technique(CLEAN-NET),and non-exposed endoscopic wall-inversion surgery(NEWS).These methods of local resection have the advantages of minimal invasion,shorter operation time,and less blood loss compared to conventional gastrectomy.Concerning the issue of lymph node dissection in combined laparoscopy-endoscopy surgery,sentinel node navigation can be the solution,although cumbersome intraoperative lymph node tracing,operative failure and false negative still exist.As a developing treatment for EGC,combined laparoscopy-endoscopy local resection will have a good application prospect in the future.

关 键 词：胃肿瘤 早期 腹腔镜-内镜联合手术 局部切除 前哨淋巴结导航手术 

分 类 号：R735.2[医药卫生—肿瘤]