The first domestic experience of endoskopichesky removal of a podslizisty tumor of a gullet, by tunneling of a podslizisty layer by means of a dissektsiya
The material is provided by the Medical center "Clinic 31".
In recent years the technique of an endoskopichesky resection of a tumor is developed for removal of neepitelialny tumors (NEO) of a gullet by podslizisty access (ЭРОПД). This low-invasive way showed the efficiency and is alternative to surgeries, favourably differing from the last in volume an operational trauma.
Message purpose: to present the first experience of endoskopichesky removal of NEO of the gullet which is starting with a muscular cover, by tunneling of a podslizisty layer by means of a podslizisty dissektsiya.
Materials and methods: 29.02.2012г. in our clinic, a joint brigade, within a scientific and practical seminar, it was made ЭРОПД at the patient of B., 54 years with NEO of abdominalny department of a gullet. This tumor, the sizes of 13х15 mm, was revealed for the first time in 2006 at skriningovy out-patient EGDS. At annual control the tumor remained the former sizes and a form. In January, 2012 the ulceration on a tumor top in diameter of 2-3 mm in this connection to the patient the endoskopichesky ultrasonografiya was recommended and executed was revealed. At EUS in abdominalny department of a gullet there was a tumor of homogeneous structure with the individual gipoekhogenny center in the center (most likely, лейомиома) a roundish form in the size of 13-15 mm, located in deep layers of a mucous membrane; disappearance of layers of a mucous membrane was defined on surfaces of education throughout 2-3 mm, most likely, at the expense of an ulceration. On visible sites podslizisty and muscular layers of a wall of a gullet were distinctly traced over education that allowed to draw a conclusion that most likely NEO starts with a muscular plate of a mucous membrane.
Results: Operative intervention carried out under an endotrakhealny anesthesia. At a diagnostic stage it was revealed that on the left wall of abdominalny department of a gullet, periodically пролабируя in a stomach, there is dense, roundish and moderately mobile NEO in diameter of 15 mm with granulyatsionny fabrics on a top. The longitudinal section in mucous length to 2 cm was executed in 5 cm proksimalny tumors, after a podslizisty injection of 10 ml of physiological solution with the indigokarminy. With use of a trihedral knife of KD-640L and the electrosurgical ERBE VIO 300D block (Germany) by a dissektsiya of a podslizisty layer in a mode spray coagulation, creation of the podslizisty tunnel leaving on 2 cm distalny tumor was executed. It was revealed that a solitarny tumor with a smooth capsule, settling down in a podslizisty layer, starts with own muscular layer, being related thin "leg". With the help spray coagulation the tumor was «вылущена» within healthy fabrics for 90 % of the surface. Final removal of a tumor within not changed fabrics was executed by means of the polipektomichesky loop imposed on muscular "leg" of a tumor. The small opening in a mucous membrane, in a projection of earlier existing site of an ulceration was successfully klipirovano. Besides, by imposing 5 more клипс entrance defect of a mucous membrane was taken completely in".
The general time of intervention made 60 minutes. Intra-and the patient had no postoperative complications. For 2 days after intervention control EGDS during which tightness of all earlier imposed клипс is ascertained is executed.
Conclusion: endoskopichesky removal of neepitelialny tumors of a gullet by tunneling by means of a podslizisty dissektsiya is malotravmatichny and rather safe procedure and can be considered alternatively to traditional surgeries at similar patients.
E.D.Fyodorov, H.Inouye, R.V.Plakhov, Z.V.Galkova, O.I.Yudin, E.V.Ivanova, M.E.Timofeev, M.T.Taymaskina, D.E.Seleznyov, R. Mazelli, M of Century Zadorozhny, V.S.Osipova, A.V.Shmakov
NOTs of abdominalny surgery and endoskopiya to RNIMA of N.I.Pirogov (the manager. – prof. Of this year Shapovalyants).
GKB No. 31 (hl. the doctor – the member correspondent of the Russian Academy of Medical Science, prof. G.N.Golukhov), MTs KLINIKA+31 (hl. the doctor – B.T.Churadze) Moscow, Russia.