| 特集名 | 早期消化管癌に対するEMR -- 適応拡大をめぐる問題 | |
|---|---|---|
| 題名 | 食道表在癌に対するEMR (2) 食道癌に対するEMRの選択方法;新しいEMR手技 -- Hooking EMR methodの有用性 | |
| 発刊年月 | 2001年 11月 | |
| 著者 | 小山 恒男 | 佐久総合病院胃腸科 |
| 著者 | 菊池 勇一 | 佐久総合病院内視鏡室 |
| 著者 | 友利 彰寿 | 佐久総合病院胃腸科 |
| 著者 | 堀田 欣一 | 佐久総合病院胃腸科 |
| 著者 | 島谷 茂樹 | 佐久総合病院胃腸科 |
| 著者 | 宮田 佳典 | 佐久総合病院胃腸科 |
| 【 要旨 】 | EMRは食道表在癌治療の第一選択手技であるが，食道は内腔が狭くスコープの操作性が悪いため，正確で大きな切除が難しく，多くの症例で分割切除が施行されてきた．そこで大きく，正確な切除を施行するためにわれわれはhooking EMR法を開発した． ヨード染色後にマーキングを施行し，粘膜下層に局注した後にneedle knifeで病変周囲粘膜を切開する．次にneedle knifeの先端を1mm直角に屈曲させ，かつ回転機能を有するhooking knifeを用いて粘膜下層の線維を切離し病変を切除する． hooking EMRでは正確で大きな一括切除が可能であり(自験例では長径75mmの一括切除も可能であった)，今後標準的なEMR術式になりうると思われた． |
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| Theme | Expansion of Indications for Endoscopic Mucosal Resection of Early Gastrointinal Cancer | |
|---|---|---|
| Title | Endoscopic Mucosal Resection using Hooking knife (hooking EMR) for Esophageal Early Cancer | |
| Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
| Author | Yuichi Kikuchi | Department of Endoscopy, Saku Central Hospital |
| Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
| Author | Kin-ichi Hotta | Department of Gastroenterology, Saku Central Hospital |
| Author | Shigeki Shimaya | Department of Gastroenterology, Saku Central Hospital |
| Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
| [ Summary ] | The lymphnodal metastasis of esophageal mucosal squamous cell carcinoma is very rare. Therefor, endoscopic mucosal resection (EMR) was selected for the treatment of those diseases, instead of esophagectomy. However, the size of endoscopic resected specimens was 10-20mm, so piecemeal resection was performed on large lesions. The histological examination of piecemeal resected specimens was difficult, compared with en-bloc resected specimens. We developed a new EMR method called "Hooking EMR" to resect larger enbloc specimens. At first, we placed marks around the lesion using a coagulation needle. Then, a saline diluted epinephrine solution was injected into the submucosal layer, to separate the mucosal lesion from the muscular layer proper. Then, we cut the mucosa, using a needle knife. Next, we cut the submucosal fibers, using a hooking knife, and resected the lesion without using a snare. A large en-bloc resection, 70mm or more over in size, was possible with this new method. Therefor, the histological examination of both the range of lateral spread and depth of invasion can be more precisely performed. The hooking EMR method is a new, useful EMR method for the wider precise use of EMR. |
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