Natural orifice transluminal endoscopic mediastinal surgery: NOTEMS, a promising field for endotherapy
Natural orifice transluminal endoscopic mediastinal surgery: NOTEMS, a promising field for endotherapy
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自然孔腔内窥镜纵隔手术：NOTEMS，内科治疗的一个有前景的领域
DOI：
10.1055/a-1540-5732
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发表时间：
2021-08
期刊：
影响因子：
9.3
通讯作者：
Ping-Hong Zhou
中科院分区：
文献类型：
--
作者：
Ping-Ting Gao;Sheng-Li Lin;Pei-Yao Fu;Xin-Yang Liu;Quan-Lin Li;Wei-Feng Chen;Ping-Hong Zhou
纵隔由于其复杂多变的解剖结构，过去一直是内镜治疗的禁区[1]。传统手术被认为是治愈性的，但带来了巨大的创伤，恢复时间长，成本高，生活质量差[2]。为了克服这些缺点，在我们以前的工作中，我们报告了一种新的方法，使用狭窄的粘膜下隧道或“第三空间”作为进入纵隔腔的手术入口[3]。然而，我们仍然遇到了几个问题。当肿瘤位于高于22厘米的门牙，这是不可能的开始隧道入口5厘米以上的肿瘤部位。此外，当肿瘤直径大于5 cm时，不能在不损伤粘膜的情况下通过隧道将其整体取出，而是必须逐块取出。我们渴望更新内窥镜手术，以改善这种肿瘤的方法。在此，我们报道了一种新的技术，称为自然腔道经腔内镜纵隔手术（NOTEMS），该技术包括食管壁的全层切除以解剖纵隔腔中的肿瘤，然后用金属夹沿着用生物胶闭合伤口，以治疗上食管周围的大型纵隔肿瘤（图10）。1）。使用NOTEMS，我们成功地治疗了一名30岁的患者，该患者因在常规食管胃镜（EGD）常规检查中发现食管粘膜下肿瘤（SMT）而入院（图10）。2）。通过胸部计算机断层扫描和内镜超声检查，SMT被诊断为巨大的后上E-Videos
The mediastinum used to be a forbidden area for endotherapy because of its complicated and variable anatomical structure [1]. Traditional surgery is regarded as curative but brings with it great trauma, a long recovery, high costs, and a poor quality of life [2]. To overcome these disadvantages, in our previous work we reported a novel approach to paraesophageal structures using the narrow submucosal tunnel or “third space” as an operating entry into the mediastinal cavity [3]. However, we still encountered several problems. When tumors are located higher than 22cm from the incisors, it is impossible to start the tunnel entry 5 cm above the tumor site. In addition, when the tumor is larger than 5 cm in diameter, it cannot be taken out through the tunnel en bloc without injuring the mucosa, but has to be removed piecemeal instead. We are eager to update endoscopic procedures to improve the approach to such tumors. Herein, we report on a novel technique, called natural orifice transluminal endoscopic mediastinal surgery (NOTEMS), which involves full-thickness resection of the esophageal wall to dissect the tumor in the mediastinal cavity, followed by closure of the wound by metallic clips along with biological glue, to treat large mediastinal tumors around the upper esophagus (▶Fig. 1). Using NOTEMS, we successfully treated a 30-year-old patient admitted because of an esophageal submucosal tumor (SMT) found on routine check-up by regular esophagogastroduodenoscopy (EGD) (▶Fig. 2). By means of computed tomography of the chest and endoscopic ultrasonography the SMT was diagnosed as a giant posterosuperior E-Videos
DOI：
10.1007/s00428-015-1830-8
发表时间：
2015-11
期刊：
Virchows Archiv : an international journal of pathology
影响因子：
--
作者：
den Bakker MA;Marx A;Mukai K;Ströbel P
通讯作者：
Ströbel P
DOI：
10.1016/j.jamcollsurg.2006.07.022
发表时间：
2006-11-01
影响因子：
5.2
作者：
Petty, John K.;Bensard, Denis D.;Karrer, Frederick M.
通讯作者：
Karrer, Frederick M.