中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (10): 1155-1158.DOI: 10.19538/j.cjps.issn1005-2208.2024.10.15

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术前内镜下钛夹定位联合术中内镜和冰冻病理检查用于食管胃结合部腺癌腹腔镜手术切缘判定价值研究

杨    瑞1，宋东阳2，崔    鹏2，魏    伟2，宗    亮2，乔    鋆2，王    楠2，王    博3，徐泽坤3，齐韶铭3，胡文庆2，刘    晖2   

  1. 1山西医科大学附属运城市中心医院消化内科，山西运城 044099；2山西省恶性肿瘤（食管胃结合部癌）临床医学研究中心 长治医学院附属医院  长治市人民医院胃肠外科，山西长治 046099；3长治医学院研究生处，山西长治 046000
  • 出版日期:2024-10-01 发布日期:2024-10-24

  • Online:2024-10-01 Published:2024-10-24

摘要： 目的    探讨术前内镜下钛夹定位联合术中内镜检查及术中切缘冰冻切片病理检查在食管胃结合部腺癌（AEG）腹腔镜手术中的应用价值。方法    回顾性分析2021年1月至2022年12月长治市人民医院胃肠外科收治的行腹腔镜手术治疗的133例AEG病人的临床资料。所有病例手术切缘判定均采取术前钛夹定位联合术中内镜检查及切缘冰冻切片病理检查的策略。主要观察指标包括胃镜定位时间、切缘阳性率、并发症、住院时间、非计划二次手术率和病死率。结果    术中胃镜定位时间为（4.2±1.3）min，前6例平均定位时间为7.4 min。首次术中冰冻切片病理检查中，4例（3.0%）病人切缘阳性，第2次病理检查结果均为阴性。术中未出现吻合口漏等并发症。术后有4例（3.0%）病人出现声音嘶哑和咽喉疼痛，其中1例伴左侧环杓关节半脱位，经治疗后均缓解。12例病人发生Clavien-Dindo分级≥Ⅲ级并发症，总并发症发生率为9.0%，均通过保守治疗痊愈，无需二次手术，且围手术期无死亡病例。住院时间为（12.0±4.7）d。结论    对于腹腔镜AEG手术，术前内镜下钛夹定位联合术中内镜及切缘冰冻切片病理检查的组合策略有助于实现肿瘤精准切除和切缘阴性。

关键词: 食管胃结合部腺癌, 腹腔镜, 切缘定位, 术中内镜, 钛夹定位

Abstract: To preliminarily explore the application value of preoperative titanium clip positioning combined with intraoperative endoscopy and intraoperative quick-frozen pathology for the margin analysis in laparoscopic surgery for adenocarcinoma of the esophagogastric junction (AEG). Methods    A retrospective analysis was conducted on the clinical data of 133 patients who underwent laparoscopic surgery for AEG between January 2021 and December 2022 at Changzhi People's Hospital. All patients received preoperative titanium clip positioning, intraoperative endoscopy, and intraoperative quick-frozen pathology margin analysis. Observational indicators included: Intraoperative endoscopic positioning time, the first positive resection margin rate, postoperative complications, postoperative hospital stay, rate of unplanned reoperations during the perioperative period, and mortality rate. Results    The mean intraoperative endoscopic positioning time was (4.2±1.3) min, with an average time of 7.4 minutes for the first 6 cases. The first positive resection margin rate was 3.0%, but all were negative upon the second examination. No anastomotic leakage or other complications occurred intraoperatively. Postoperatively, 4 patients (3.0%) experienced hoarseness and sore throat, with 1 case of partial subluxation of the left cricoarytenoid joint, which resolved after treatment. 12 patients developed complications classified as Clavien-Dindo grade ≥Ⅲ, with an overall complication rate of 9.0%. All patients recovered with conservative treatment, without the need for secondary surgery, and no perioperative mortality was observed. The mean hospital stay was (12.0±4.7) d. Conclusion  Preoperative endoscopic titanium clip positioning combined with intraoperative endoscopy and quick-frozen pathology margin analysis can potentially enable precise tumor resection and achieve negative surgical margins in laparoscopic AEG surgery.

Key words: adenocarcinoma of esophagogastric junction, laparoscopy, resection margin positioning, intraoperative gastroscopy, titanium clip positioning ,