胃肠道病变磁体预标记辅助腹腔镜定位术初探

Magnetic tracer technique in laparoscopic localization for gastrointestinal lesions

目的评估胃肠道病变磁体预标记辅助腹腔镜定位术的可行性及安全性。方法2019年4月至6月,拟行腹腔镜根治术的胃、结直肠肿瘤住院患者8例,在行腹腔镜切除术前接受了内镜下磁体预标记,即在病变旁用钛夹固定一枚磁体进行病变标记。术中通过腹腔镜孔道送入另一枚磁体,在磁体相互吸引力导引下,快速与病变附近预标记的磁体隔胃肠道壁而吸引在一起,实现病变定位。对8例患者的术前标记及手术情况进行分析和总结。结果8例患者术前均内镜下成功标记病灶,并实现了术中快速准确定位。内镜下标记用时为(5.75±2.45)min,术中定位用时(1.94±0.56)min。患者均完成腹腔镜肿瘤切除术,定位准确,结直肠肿瘤病灶平均近端和远端切除边缘分别为105 mm和74 mm,无任何并发症发生。结论胃肠道病变磁体预标记辅助腹腔镜定位术简便、安全、准确,同时无需额外诊治设备及消化内镜术中配合操作。

Objective To evaluate the feasibility and safety of magnetic tracer technique for preoperative endoscopic marking in laparoscopic surgery.Methods In the preliminary study,a total of 8 patients with gastric(n=3)or colorectal(n=5)tumors underwent endoscopic magnetic marking before laparoscopic surgery from April to June in 2019.First,a magnet was attached to the lesion by 2 titanium clips under the endoscope.Second,during the subsequent laparoscopic operations,the other magnet was sent to the vicinity of the lesion through the laparoscopic tunnel.The magnet in the abdominal cavity was quickly attracted to the one in the gastrointestinal tract to successfully locate the lesions.Data of preoperative marking and operations of 8 patients were reviewed.Results All 8 lesions were marked successfully,rapid and accurate intraoperative positioning was achieved.The mean time of endoscopic marking was 5.75±2.45 minutes,and the mean time of intraoperative localization was 1.94±0.56 minutes.All patients underwent laparoscopic tumor resections with accurate localization.The mean proximal and distal resection margins of colorectal tumors were 105 mm and 74 mm respectively.No complications occurred.Conclusion Magnetic tracer technique for laparoscopic localization,simple,safe and accurate for gastrointestinal lesions,can be performed without additional equipment or endoscopic procedures involved.