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 2 gastric central cancer.
目的： 评价胃镜钛夹定位联合CT三维重建对腹腔镜下早期胃癌手术切缘控制的效果。方法： 对2017年10月至2019年1月在浙江省人民医院胃肠胰外科接受腹腔镜手术的病灶位于胃中部的T1~2期胃癌患者进行前瞻性研究。25例患者入组，男性17例，女性8例，年龄（63.6±7.2）岁（范围：48~77岁）。术前采用胃镜下病灶钛夹定位联合CT三维重建的方法，构建胃腔与病灶的虚拟全貌，设计手术切缘；术中根据术前设计的手术切缘实施腹腔镜下手术切除。比较CT三维重建和标本解剖测得的胃角至切缘小弯侧起点距离、胃角至病灶中心距离和上切缘距离。统计学分析采用配对t检验。结果： CT三维重建和标本解剖测得的胃角至病灶中心距离[ （2.67±1.38） cm比（2.83± 1.56） cm，t=1.51 ，P=0.14]和上切缘距离[（5.23±0.60）cm比5 cm，t=1.93，P=0.07]无明显差异，两种方法测得的胃角至切缘小弯侧起点距离差异有统计学意义[（5.94±0.94）cm比（6.37±0.90）cm ，t=3.52 ，P= 0.00]。结论： 采用胃镜下钛夹定位联合CT三维重建可以较准确地对T1~2期胃中部癌进行腹腔镜下定位和切缘控制。.
Keywords: Gastroscopy; Imaging, three-dimensional; Laparoscopy; Margin; Stomach neoplasms; Tomography, spiral computed; Tumor localization.