Kondo Hitoshi, Gotoda Takuji, Ono Hiroyuki, Oda Ichiro, Kozu Takahiro, Fujishiro Mitsuhiro, Saito Daizo, Yoshida Shigeaki
Center for Digestive Diseases, Tonan Hospital, Sapporo, Japan.
Gastrointest Endosc. 2004 Feb;59(2):284-8. doi: 10.1016/s0016-5107(03)02533-1.
EMR now is accepted as a minimally invasive treatment for early stage gastric cancer. However, the endoscopic approach sometimes is limited by the size and location of the tumor. The technique and early results of percutaneous, traction-assisted EMR for resection of larger early stage gastric cancers is described.
EMR, by using an insulation-tipped electrosurgical knife, was performed with the simultaneous assistance of laparoscopy devices. A small snare was introduced into the gastric lumen through a gastric port (2-mm diameter) to grasp and pull the EGC away from the muscularis propria to facilitate resection.
The technique was performed successfully in our endoscopic suite in the first patient under general anesthesia and the remaining seven under conscious sedation. Tumors situated in any part of the stomach could be reached with percutaneous assistance, and this facilitated en bloc resection of large specimens (mean size 50 mm). The procedure was performed in about 60 minutes. Seven patients (88%) resumed eating 1 or 2 days after surgery. All patients were discharged after 1 week without complication.
Percutaneous, traction-assisted EMR is useful for resection of large lesions en bloc and can be performed easily and safely under direct vision.
内镜黏膜切除术（EMR）目前被认为是早期胃癌的一种微创治疗方法。然而，内镜治疗方法有时会受到肿瘤大小和位置的限制。本文描述了经皮牵引辅助EMR切除较大早期胃癌的技术及早期结果。
使用绝缘头电刀进行EMR，并同时借助腹腔镜设备。通过一个胃端口（直径2毫米）将一个小圈套器引入胃腔，以抓住并将早期胃癌从固有肌层拉开，便于切除。
首例患者在全身麻醉下于我们的内镜手术室成功实施了该技术，其余7例在清醒镇静下完成。在经皮辅助下，胃内任何部位的肿瘤均可触及，这有利于完整切除大标本（平均大小50毫米）。手术过程约60分钟。7例患者（88%）术后1或2天恢复进食。所有患者术后1周出院，无并发症。
经皮牵引辅助EMR有助于完整切除大的病变，并且可以在直视下轻松、安全地进行。
