胃肠肿瘤腹腔镜手术中内镜检查的应用价值

Value of Endoscopic Examination during Laparoscopic Surgery for Gastrointestinal Tumors

目的评价胃肠肿瘤腹腔镜手术中内镜检查的应用价值。方法回顾分析2004年1月～2008年11月我院505例胃肠肿瘤腹腔镜手术中39例(7.7%)术中内镜检查的临床资料。结果 32例以定位病变为指征,其中30例找到病变,检出率达93.8%(30/32);5例以评价吻合口为指征,术后均未出现吻合口狭窄,其中3例同时内镜定位病变切除了合并存在的结肠腺瘤;1例术中出血,行术中内镜明确了出血部位;1例拟在腹腔镜辅助下行内镜下胃脂肪瘤切除,因内镜下注射后抬举征阴性,提示病变深度超过黏膜下层,故改为腹腔镜下切除。结论术中内镜检查对腹腔镜胃肠肿瘤手术病变定位及吻合口评估有重要价值。

Objective To evaluate the value of intraoperative endoscopy during laparoscopic surgery for patients with gastrointestinal tumor. Methods During January 2004 to November 2008,505 patients with gastrointestinal tumor underwent laparoscopic surgery in our hospital,intraoperative endoscopy was performed on 39 of the patients （7.7%）. We reviewed the data of the patients. Results Among the patients,the indication for intraoperative endoscopy was localization of the lesion in 32 patients,and diseased segment was detected in 30 of them （93.8%） successfully. Assessment of the anastomosis was the main indication in 5 patients; none of them had postoperative anastomotic stenosis. Three patients was diagnosed as complicating with colonal adenoma and thus received polypectomy by endoscopy. One patient developed hemorrhage during the laparoscopy,and the bleeding site was successfully identified by intraoperative endoscopy. In one patient,who had gastric lipoma and was going to receive laparoscopic-assisted endoscopic resection,endoscopy showed the depth of the lesion beyond the submucosal layer,and thus laparoscopic resection was carried out. Conclusions Intraoperative endoscopy is of great value in tumor localization and anastomosis evaluation during laparoscopic surgery for gastrointestinal tumors.