Developments in flexible endoscopic surgery: a review.
Developments in flexible endoscopic surgery: a review.
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DOI：
10.2147/ceg.s46584
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发表时间：
2015
影响因子：
2.4
通讯作者：
Wilhelm D
中科院分区：
文献类型：
--
作者：
Feussner H;Becker V;Bauer M;Kranzfelder M;Schirren R;Lüth T;Meining A;Wilhelm D
柔性内窥镜正日益发展成为一种治疗性的而不是纯粹的诊断性学科。改进的可视化使早期病变易于检测，并使我们能够决定所需的治疗。深层肠镜检查允许探索甚至小肠-长期以来是胃肠内窥镜检查的“白色斑点”-并进行直接治疗。内镜粘膜下剥离术是一个相当大的进步，在肿瘤学正确的内镜治疗（早期）恶性病变。虽然在技术上仍然具有挑战性，但新的操作技术和工具正在稳步优化，这越来越便利。可显著改善室壁缺损的闭合和止血。甚至胃肠道壁以外的解剖结构也正在通过腔内超声的治疗用途进行探索。如果传统的内镜逆行胰胆管造影术失败，超声内镜引导的手术不仅是一个合适的后备解决方案，甚至使坏死切除术，脓肿引流，神经松解术可行的内窥镜。新开发的内镜方法针对以前独特的外科领域，如胃食管反流病，阑尾炎和胆囊炎。联合内镜/腹腔镜介入技术可能成为自然腔道内镜手术的先驱，而纯自然腔道内镜手术目前仍处于起步阶段。
Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a “white spot” for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings.