论文部分内容阅读
食道肿瘤大多采用内窥镜下黏膜切除术(endoscopic mucosal resection,EMR)技术,考虑到“整块切除”和切除深度的问题存在一定技术缺陷,随着内镜技术发展而来的内窥镜黏膜下剥离术(endoscopic submucosal dissection,ESD)技术可以弥补EMR的部分缺陷,并已经成为治疗胃肠道肿瘤的标准术式。然而ESD技术从操作上来讲还是较为困难的,ESD的操作时间较EMR长,术中出血、穿孔等并发症的发生率较EMR高。近来,带导丝的钛夹、外部钳夹、圈套器、内牵引、双内镜、磁性锚等多种牵引技术的引入可以辅助ESD简化操作。所有技术都应根据术中肠道内的解剖特点进行合理应用。本文对近年来提出的ESD牵引技术进行综述,讨论各种技术的特点和优势。
Most of esophageal tumors using endoscopic mucosal resection (endoscopic mucosal resection, EMR) technology, taking into account the “whole block removal” and removal of the depth of the problem there are some technical defects, with the endoscopic technology developed from the end Endoscopic submucosal dissection (ESD) can make up for some of the defects of EMR and has become the standard procedure for the treatment of gastrointestinal tumors. However, the ESD technology is still more difficult to operate. The operating time of ESD is longer than that of EMR. The incidence of intraoperative bleeding, perforation and other complications is higher than that of EMR. Recently, the introduction of a variety of traction techniques with wire guide titanium clip, external forceps, snare, internal traction, dual endoscopy, magnetic anchor can help simplify the operation of ESD. All techniques should be based on intraoperative anatomical features of the gut for reasonable use. This article summarizes the ESD traction technologies proposed in recent years and discusses the features and benefits of various technologies.