Ishimaru Tetsuya, Hatanaka Akira, Takazawa Shinya, Konishi Kenichiro, Iwanaka Tadashi
Department of Pediatric Surgery, The University of Tokyo Hospital , Tokyo, Japan .
J Laparoendosc Adv Surg Tech A. 2014 Apr;24(4):268-73. doi: 10.1089/lap.2013.0504. Epub 2013 Nov 28.
This study aimed to develop new devices for translumenal endoscopic esophageal anastomosis-a stent and a ligating device-and to confirm the feasibility of our novel procedure using those devices.
We designed a ligating device as an overtube whose tip worked like the EVL device (Sumitomo Bakelite Co. Ltd., Tokyo, Japan). The newly developed procedure for anastomosis is as follows: a silicone elastic band, which was released from the device located at the upper esophagus, and a custom-made expandable stent, which was expanded by the balloon catheter in the lower esophagus, tightened the upper and lower esophageal walls. After producing the devices, we performed the anastomosis procedure in porcine models.
A ligating device and an expandable stent were developed for this study. An ex vivo feasibility study was performed in three porcine models. Endoscopic visualization revealed that all steps in this procedure were technically successful. The median time needed to perform this procedure was 24 (range, 19-25) minutes. Patency of the anastomosis was confirmed in all specimens.
Translumenal esophagoesophageal anastomosis using the new devices was feasible. The procedure time was sufficiently short for clinical use. An in vivo survival study is needed to confirm the safety and reliability of this procedure.
本研究旨在开发用于经腔内镜食管吻合术的新装置——一种支架和一种结扎装置，并证实使用这些装置进行我们新方法的可行性。
我们设计了一种作为外套管的结扎装置，其尖端的工作方式类似于套扎装置（住友电木株式会社，东京，日本）。新开发的吻合术步骤如下：从位于食管上段的装置释放的硅胶弹性带，以及在下段食管中由球囊导管扩张的定制可扩张支架，将食管上下壁收紧。制作出这些装置后，我们在猪模型中进行了吻合术。
为该研究开发了一种结扎装置和一种可扩张支架。在三个猪模型中进行了体外可行性研究。内镜观察显示该手术的所有步骤在技术上均成功。进行该手术所需的中位时间为24（范围19 - 25）分钟。所有标本的吻合口均通畅。
使用新装置进行经腔食管食管吻合术是可行的。手术时间足够短，可用于临床。需要进行体内生存研究以证实该手术的安全性和可靠性。
