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Forgione A, Leroy J, Soler L, Marescaux J. 虛擬結腸鏡檢查：術前和術中大腸直腸檢查息肉的新策略. Epublication: WeBSurg.com, Dec 2004;4(12). URL: http://www.websurg.com/ref/doi-vd01tw1560.htm
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General and digestive > Colon > Polyps

A Forgione (Italy), J Leroy (France), L Soler (France), J Marescaux (France)

December 2004
Traditional Chinese - 04'00''

 
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00'09'' 案例報告
本影片介紹利用虛擬大腸鏡檢查辨識大腸息肉。案例是一名73歲男性，出現泌尿道感染。過去病史包括腎血管性高血壓與裝置節律器。綜合臨床評估的一部份包括光學大腸鏡檢查。發現有梗腺瘤(pedunculated adenoma)，位於結腸之息肉，以內視鏡切除。其他無梗之分化不佳的腺瘤，不好用內視鏡檢查的位置，無法以內視鏡切除。
00'35'' 虛擬重建和偵測息肉
大腸鏡檢查顯示腔室內病灶。使用16切掃描器進行 CT掃描，同時自動充氣，以維持大腸充氣。屏氣凝神進行掃描。在我們的研究中心，用3D虛擬重建軟體評估虛擬大腸鏡的效果，以分析大腸病灶的位置。此軟體的好處之一，是可以看見大腸的腔室模型，因此促進軟體偵測病灶的能力，特別是平面部分 。現在進行虛擬導航，這讓我們透過虛擬大腸鏡看見大腸腔室。左邊的影像指出虛擬大腸鏡的位置，繼續導航直到到達病灶，即綠色區域所指處。證據指出息肉位置在橫結腸。虛擬實境比2D CT掃描更可以排除人工發現。此處的證據顯示息肉看似壓迫到大腸腔，這是由軟體系統所建立的影像。透過此技術，我們目標在發展使用虛擬實境進行大腸息肉的自動偵測。
02'12'' 手術中偵測息肉
現在到手術視野。決定進行片段切除發病部位的結腸。因為繫膜靠近息肉，所以不考慮進行楔狀切除。進行術中大腸鏡檢查，以再度確認息肉位置。與虛擬大腸鏡進行比較，以幫助術中息肉定位。清楚看見息肉在橫結腸 。藉由大腸鏡導引，使用夾子進行腹腔鏡息肉標記。完成之後，可以進行片段切除。
03'05'' 大腸切除
完整的腹腔鏡曝露腹腔之後，牽引大網膜，以露出橫結腸。使用Ligasure裝置開始剝離，以分割大腸周邊脂肪和網膜。可以靠近大腸壁剝離，因為用此裝置可減少腸道熱損傷風險。在橫繫膜結腸建立視窗，需夠寬，以操作線性釘書機 。建立劍突下切口，以摘除大腸。藉由傷口保護器完成後，建立機械式側對側吻合。之後將腸子再度導入腹部。從切除處取得病理樣本，清楚看見無梗息肉 。

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Antonello Forgione 
   

Joël Leroy 
   

Luc Soler 
   

Jacques Marescaux 
 


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General and digestive > Colon > Polyps

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虛擬結腸鏡檢查：術前和術中大腸直腸檢查息肉的新策略Sequenced video A Forgione, J Leroy, L Soler, J Marescaux 2004 Dec
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