Preliminary application of endoscopic titanium clip localization combined with three?dimensional CT reconstruction in the determination of resection margin of gastric central cancer under laparoscopy
10.3760/cma.j.issn.0529?5815.2019.10.008
- VernacularTitle:胃镜钛夹定位联合CT三维重建在腹腔镜胃中部癌手术切缘判断中的初步应用
- Author:
Zhenyuan QIAN
1
;
Yang WEN
;
Guochun LOU
;
Jia ZHANG
;
Yuanyu WANG
;
Weiwei JIN
;
Yucheng ZHOU
;
Yiping MOU
Author Information
1. 浙江省人民医院胃肠胰外科 杭州医学院附属人民医院 310014
- Keywords:
Stomach neoplasms;
Imaging,three?dimensional;
Laparoscopy;
Gastroscopy;
Tomography,spiral computed;
Tumor localization;
Margin
- From:
Chinese Journal of Surgery
2019;57(10):757-762
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the accuracy of endoscopic titanium clip localization combined with CT three?dimensional reconstruction for the control of incision margin in early gastric cancer under laparoscopy. Methods A prospective analysis was made for gastric cancer whose lesions were located in the middle of the stomach and T stage was 1 to 2 from October 2017 to January 2019 at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital. Totally 25 patients were eventually enrolled in the study. There were 17 males and 8 females aging of (63.6± 7.2) years (range: 48 to 77 years). All cases were treated with titanium clip localization under endoscope combined with CT three?dimensional(3D) reconstruction to construct a virtual panorama of gastric cavity and lesions, and to design surgical margins. Laparoscopic surgical resection was performed according to the surgical margins designed before operation. The distance from the gastric angle to the origin of the minor curvature of the incisional margin, the distance from the gastric angle to the the center of lesion and the distance of the upper incision margin were measured under three?dimensional CT reconstruction and under actual specimen. Paired t test was used to compare the three distances measured by two methods. Results The measured distances from the gastric angle to the center of the lesion and the proximal incisional margin under 3D reconstruction CT were according to the measured values of actual specimens ((2.67±1.38) cm vs. (2.83±1.56) cm, t=1.51, P=0.14; (5.23±0.60) cm vs. 5 cm, t=1.93, P=0.07); the measured distances from the gastric angle to the origin of the minor curvature of the incisional margin under CT 3D reconstruction were different with the measured values of solid specimens ((5.94±0.94) cm vs. (6.37±0.90) cm, t=3.52, P=0.00). Conclusion The method of titanium clip localization combined with CT 3D reconstruction can provide a feasible laparoscopic localization method and incision edge solution for T1 to T2 gastric central cancer.
