剪刀型内镜切开刀在困难部位内镜黏膜下剥离术治疗中的应用*

目的探讨应用剪刀型内镜切开刀在困难部位进行内镜黏膜下剥离术(ESD)治疗的可行性和安全性。方法选取2015年6月-2018年6月发现的消化道早癌及癌前病变患者29例,拟于该科行ESD,但术前判断预计操作比较困难的患者应用剪刀型内镜切开刀(日本住友电木株式会社MD-47703 Jr型VS刀)进行ESD。结果所有患者均成功完成了ESD操作并获得整块切除,未发生消化道穿孔、大出血等治疗相关并发症。病灶平均大小(3.70±1.09)cm,平均治疗时间(64.83±17.77)min。病理判断:术后所有患者垂直切缘及水平切缘均为阴性,其中6例食管病变及1例胃体病变患者发现癌变,其血管、淋巴管及神经均阴性,且浸润深度均未超过黏膜下层200μm,均判断为治愈性切除,无需追加外科手术治疗,治愈性切除达100.0%。结论剪刀型内镜切开刀进行ESD治疗操作简单、整块切除率高、并发症发生率低,大大降低了ESD操作的门槛,有利于临床的推广普及。

Forficiform knife for the difficult endoscopic submucosal dissection*

Objective To evaluate the feasibility and safety of forficiform knife in the difficult endoscopic submucosal dissection.Methods From June 2015 to June 2018,29 patients who were scheduled an endoscopic submucosal dissection(ESD)for early gastrointestinal cancer or precancerous lesion were enrolled and treated with for ficiform knife(MD-47703 Jr type VS knife).All the patients were regarded as difficult for the ESD procedure by preoperative evaluation.Results All the 29 patients were resected en bloc.No complications such as perforation,hemorrhage occurred during or after the procedure of ESD.The mean size of lesion was(3.70±1.09)cm,the average operating time was(64.83±17.77)min.All these lesions were classified as curative resection by post-ESD histopatholoy with negative lateral and vertical margin.Conclusion The using of forficiform knife during ESD not only lowers the difficulty but also increases the safety of procedure.