| 特集名 | EUSによる診断と治療 -- 現状と将来展望 | |
|---|---|---|
| 題名 | 英国におけるinterventional EUSの研究動向 | |
| 発刊年月 | 2005年 10月 | |
| 著者 | 池田 圭一 | Department of Surgical Oncology and Technology, St Mary's Hospital, London, UK / Department of Medical Physics, University College London, UK / 東京慈恵会医科大学内視鏡科 |
| 著者 | Paul Swain | Department of Surgical Oncology and Technology, St Mary's Hospital, London, UK / Department of Medical Physics, University College London, UK |
| 著者 | Annette Fritscher-Ravens | Department of Endoscopy, St Mary's Hospital, London, UK |
| 著者 | 角谷 宏 | 東京慈恵会医科大学内視鏡科 |
| 著者 | 田尻 久雄 | 東京慈恵会医科大学内視鏡科 |
| 【 要旨 】 | 開腹や全身麻酔を要しない低侵襲治療を目指し，消化管経由で腹腔内の臓器にアプローチする経消化管的内視鏡手術が盛んに開発，研究されている．本稿では超音波内視鏡 (EUS) の穿刺針を使用する新しい縫合法を応用した，経胃的胃食道逆流症手術と経消化管的消化管吻合術に関して，英国における基礎実験の成績を中心に，新技術の開発動向とあわせて概説した．EUSを用いることでより正確な目的臓器へのアプローチが可能であり，本稿で述べたEUS穿刺針を用いた新しい縫合法と組み合わせることで，多様な経消化管的内視鏡手術への応用が期待される． | |
| Theme | Present Status and Future Aspects of EUS | |
|---|---|---|
| Title | New Developments of Interventional EUS in UK | |
| Author | Keiichi Ikeda | Department of Surgical Oncology and Technology, St Mary's Hospital, London, UK / Department of Medical Physics, University College London, UK / Department of Endoscopy, The Jikei University School of Medicine |
| Author | Paul Swain | Department of Surgical Oncology and Technology, St Mary's Hospital, London, UK / Department of Medical Physics, University College London, UK |
| Author | Annette Fritscher-Ravens | Department of Endoscopy, St Mary's Hospital, London, UK |
| Author | Hiroshi Kakutani | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Hisao Tajiri | Department of Endoscopy, The Jikei University School of Medicine |
| [ Summary ] | Transgastric endoscopic surgery has been developed to allow incisionless, minimally invasive treatment without requiring anaesthesia, laparoscopy or open surgery. The invention of new endosurgical methods and devices for application at EUS might promote development of a new type of surgery that would permit manipulation of structures deep within or outside the GI tract wall with high-quality, real-time US imaging. New sewing methods using EUS-FNA needle have been developed to perform transgastric gastroesophageal reflux surgery and transgastric tissue anastomosis. The aim of the study is to define the EUS anatomy of structures outside the gut that influence reflux, to place stitches in the median arcuate ligament, to perform posterior gastropexy, and to test the feasibility of crural repair under EUS control in pigs. We also developed methods of forming an anastomosis at flexible endoscopy, such as a gastrojejunostomy or cholecystoduodenostomy, when access to only one lumen is feasible. It was feasible to perform transgastric gastroesophageal reflux surgery and to form tissue anastomoses using the new sewing method at flexible endoscopy. Suturing under real-time EUS control offers significant advantages in terms of the further development of endosurgery. Linear EUS allows approaching to the target organ much more precisely, and is expected to lead to various transgastric endoscopic surgery combined with the new sewing method modified the EUS-FNA technique. | |