腹腔镜辅助下经胃内镜腹膜后淋巴结活检术一例

Laparoscopy-assisted trans-gastric endoscopic biopsy of retroperitoneal lymph node： a report of 1 case in human being

目的初步评价利用现有器械进行腹腔镜辅助下经胃内镜腹膜后淋巴结活检的可行性。方法在腹腔镜辅助下实施了1例经胃内镜腹膜后淋巴结活检术。在腹腔镜辅助下，选择胃体下部前壁用针刀切开胃壁，置入黄斑马导丝和成型气囊扩张胃壁，内镜进入腹腔。在腹腔镜辅助下，以电活检钳通电切下肿大淋巴结2块，放入内镜网篮内，经胃壁切口进入胃腔、食管、口腔取出。以止血夹闭合胃壁切口后退镜。结果腹腔镜辅助下经胃内镜腹膜后淋巴结活检取得成功。术后病理诊断为淋巴瘤。经过1个疗程化疗后于术后第6天情况好转出院。无近期和远期并发症。结论利用现有器械进行人体腹腔镜辅助下经胃内镜腹膜后淋巴结活检术是可行的。

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery （NOTES） in human being with current available devices. Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoseopy in a 50-year-old man, who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure. After routine anesthesia and abdominal skin sterilization, a pneumoperitoneum was induced with a Veress needle placed in the umbilical area, followed by the introduction of a 5-mm trocar. Gastral cavity was sterilized with antibiotics and povidone iodine. Under laparoscopic optical control, we made a styliform incision in the anterior wall of gastric corpus with a needle knife, and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope. We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy. The specimen was taken out by retrieval basket through the stomach. The gastric incision was closed with metal clips. Results The biopsy by means of NOTES was successfully performed without intra- or postoperative complications. The diagnosis was confirmed as lymphoma pathologically. The patient received chemotherapy and was discharged on the sixth postoperative day. There was no short or long-term complication. Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.