内镜下钕铁硼磁环预标记结直肠肿瘤辅助腹腔镜定位的应用价值(含视频)  

Application value of endoscopic Nd-Fe-B magnet ring tracer technique to laparoscopy for colorectal lesions(withvideo)

作　　者：杨松[1] 郝朗松[2] 李红灵[1] 蒋远健 刘维平 Yang Song;Hao Langsong;Li Hongling;Jiang Yuanjian;Liu Weiping(Department of Endoscopy,Guizhou Provincial People's Hospital,Guiyang 550002,China;Department of Gastrointestinal Surgery,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院内镜科,贵阳550002 [2]贵州省人民医院胃肠外科,贵阳550002

出　　处：《中华消化内镜杂志》2023年第4期276-280,共5页Chinese Journal of Digestive Endoscopy

基　　金：贵州省卫生计生委科学技术基金(gzwjkj2017-1-004)。

摘　　要：目的探讨内镜下钕铁硼磁环预标记结直肠肿瘤病灶辅助腹腔镜定位的临床应用价值。方法前瞻性纳入2020年1月-2021年10月在贵州省人民医院胃肠外科拟行腹腔镜根治术的结直肠肿瘤患者51例。术前1 d在内镜下给予结直肠肿瘤病灶钕铁硼磁环预标记。腹腔镜根治术中将另外1枚钕铁硼磁环经腹腔镜套管送入腹腔, 与之前的磁环隔着肠壁相互吸引聚合在一起, 从而实现对病灶的定位。记录患者基本资料、术前内镜下预标记情况和腹腔镜手术情况。结果 51例患者均经内镜将钕铁硼磁环顺利置于结直肠肿瘤病灶处并成功固定, 其中按病变部位分为横结肠15例、降结肠12例、乙状结肠19例、直肠上段5例;按病变性质分为结肠癌21例、息肉癌变25例、侧向发育型肿瘤部分癌变5例。51例患者中有内镜黏膜切除术切缘阳性5例, 内镜黏膜下剥离术切缘阳性1例。所有病变于术中精准定位。术前标记用时(4.1±1.2)min(3~6 min), 术中定位用时(1.5±1.1)min(0.9~5.3 min), 标记及定位磁环均经腹腔镜取出体外。肿瘤病灶距近端、远端肠段切缘平均距离分别为5.5 cm、6.3 cm。无结肠黏膜损伤、出血、肠穿孔、局部炎症反应等并发症发生。结论内镜下钕铁硼磁环预标记结直肠肿瘤病灶辅助腹腔镜定位具有操作简单、快速、精准、安全等优点, 且术中无需额外设备、器械, 具有临床推广价值。ObjectiveeTo explore the clinical application value of preoperative colonoscopic marking by Nd-Fe-B magnet ring to assist laparoscopy.Methods A total of 51 patients with colorectal tumor who underwent radical laparoscopy from January 2020 to October 2021 at the Department of Gastrointestinal Surgery,Guizhou Provincial People's Hospital were recruited.The patients were marked by Nd-Fe-B magnet ring under endoscopy one day before the operation,another magnet ring was sent into the abdominal cavity during the radical laparoscopy through cannula.The two magnet rings were attracted and clung to each other to orient the lesions.The basic information of patients,location of preoperative marks under endoscopy and laparoscopy conditions were recorded.Results All 51 Nd-Fe-B magnet rings were successfully located to the position of colorectal tumor and fixed.According to the location of the lesions,there were 15 cases of transverse colon,12 cases of descending colon,19 cases of sigmoid colon,and 5 cases of upper rectal segment.According to the lesion type,there were 21 cases of colon cancer,25 cases of polyp carcinomatosis,and 5 cases of laterally spreading tumors with partial carcinomatosis.There were 5 cases with positive margins after endoscopic mucosal resection and 1 case with positive margin after endoscopic submucosal dissection.All lesions were accurately located during the operation.The marking time was 4.1±1.2 min(3-6 min)before the operation and the localization time was 1.5±1.1 min(0.9-5.3 min)during the operation.All magnet rings were removed from the body by laparoscope.The mean distances between the tumor and the cutting edge of the proximal and distal intestinal segments were 5.5 cm and 6.3 cm,respectively.No complications such as colon mucosal injury,bleeding,intestinal perforation or local inflammatory reactions occurred.Conclusion Nd-Fe-B magnet ring tracer technique for laparoscopic orientation is simple,fast,accurate and safe with no need for additional equipment or apparatus,which is worthy of clinic

关 键 词：结直肠肿瘤 腹腔镜 染色与标记 定位 钕铁硼磁环 

分 类 号：R735.34[医药卫生—肿瘤]