Dobashi Akira, Goda Kenichi, Sumiyama Kazuki, Kobayashi Masakuni, Ohya Tomohiko R, Kato Masayuki, Toyoizumi Hirobumi, Kato Tomohiro, Matsushima Masato, Tajiri Hisao
Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Department of Epidemiology, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Endosc. 2015 Nov;29(11):3373-81. doi: 10.1007/s00464-014-4031-7. Epub 2014 Dec 17.
Injection of mesna into submucosal layers was recently reported to chemically soften connective tissue and facilitate the gastric endoscopic submucosal dissection (ESD) procedure. This study aimed to evaluate the safety and feasibility of similarly using mesna for esophageal ESD (mesna ESD).
We performed mesna ESD in 20 consecutive patients with superficial esophageal squamous cell carcinomas (SESCCs). To do this, a submucosal fluid cushion was initially formed using sodium hyaluronate, and the esophageal lesion was circumferentially isolated with a short blade needle-knife. Mesna solution was then injected into the submucosal layer, which was dissected mechanically by cleavage using the tip of a cap-fitted endoscope. The number of electrosurgical incisions was recorded by computer software in real time. The data from 20 conventional ESD procedures without mesna (consecutive 10 SESCCs pre and post the 20 consecutive mesna ESD) were used for comparison to evaluate the mesna ESD.
The mesna ESDs achieved en bloc and R0 resection success rates of 100 and 95 %, respectively. There was no perforation or uncontrollable hemorrhage during and after mesna ESD, and the median procedural time of submucosal dissection was significantly less with mesna ESD than with conventional ESD (median; 8 vs. 15 min, P < 0.05). There were also significantly fewer electrosurgical incisions made during the mesna ESD than with conventional ESDs (median; 65 vs. 183 times, P < 0.01).
Mesna ESD for SESCCs is a safe procedure with the potential to facilitate esophageal ESD.
最近有报道称，将美司钠注射到黏膜下层可使结缔组织化学软化，并有助于胃内镜黏膜下剥离术（ESD）。本研究旨在评估同样使用美司钠进行食管ESD（美司钠ESD）的安全性和可行性。
我们对20例连续性浅表食管鳞状细胞癌（SESCC）患者进行了美司钠ESD。具体操作如下，首先使用透明质酸钠形成黏膜下液垫，然后用短刃针刀将食管病变进行环形隔离。接着将美司钠溶液注射到黏膜下层，使用带帽内镜尖端通过切割进行机械剥离。电外科切口数量由计算机软件实时记录。将20例未使用美司钠的传统ESD手术（20例连续性美司钠ESD手术前后各10例SESCC）的数据用于比较，以评估美司钠ESD。
美司钠ESD的整块切除率和R0切除成功率分别为100%和95%。美司钠ESD术中及术后均未发生穿孔或不可控出血，美司钠ESD黏膜下剥离的中位手术时间显著短于传统ESD（中位数：8分钟对15分钟，P<0.05）。美司钠ESD术中的电外科切口也显著少于传统ESD（中位数：65次对183次，P<0.01）。
美司钠ESD治疗SESCC是一种安全的手术方法，有可能促进食管ESD。
