nogrЭкспериментальная и клиническая гастроэнтерологияExperimental and Clinical Gastroenterology1682-8658«Global Media Technologies»10.31146/1682-8658-ecg-190-6-75-81nogr-1679Research ArticleХИРУРГИЧЕСКАЯ ГАСТРОЭНТЕРОЛОГИЯSURGICAL GASTROENTEROLOGYТуннельные эндоскопические вмешательства при патологии пищеводаTunnel endoscopic interventions in esophageal diseasesДробязгинЕ. А.DrobyazginE. A.

Дробязгин Евгений Александрович, кафедра госпитальной и детской хирургии лечебного факультета; отделение торакальной хирургии, отделение эндоскопии

630091 г. Новосибирск, ул. Красный проспект, 52

630087, г. Новосибирск, ул. Немировича- Данченко, 130

630055, г. Новосибирск, ул. Речкуновская, 15

Evgeniy A. Drobyazgin, department of hospital and children surgery; thoracic surgery department, endoscopy department

630091 Novosibirsk, Krasniy prospekt, 52

630087 Novosibirsk, Nemirovich- Danchenko str., 130

Novosibirsk, Russian Federation, 630055, Novosibirsk, Rechkunovskaya str, 15

evgenyidrob@inbox.ruЧикиневЮ. В.ChikinevYu. V.

Чикинев Юрий Владимирович, кафедра госпитальной и детской хирургии лечебного факультета; отделение торакальной хирургии, отделение эндоскопии

630091 г. Новосибирск, ул. Красный проспект, 52

630087, г. Новосибирск, ул. Немировича- Данченко, 130

Yuri V. Chikinev, department of hospital and children surgery; thoracic surgery department, endoscopy department

630091 Novosibirsk, Krasniy prospekt, 52

630087 Novosibirsk, Nemirovich- Danchenko str., 130

АрхиповД. А.ArkhipovD. A.

Архипов Дмитрий Александрович, отделение торакальной хирургии, отделение эндоскопии

630087, г. Новосибирск, ул. Немировича- Данченко, 130

Dmitri A. Arkhipov, thoracic surgery department, endoscopy department

630087 Novosibirsk, Nemirovich- Danchenko str., 130

МитькоН. И.Mit’koN. I.

Митько Никита Игоревич, кафедра госпитальной и детской хирургии лечебного факультета

630091 г. Новосибирск, ул. Красный проспект, 52

Nikita I. Mit’ko, department of hospital and children surgery

630091 Novosibirsk, Krasniy prospekt, 52

ЧекановМ. Н.ChekanovM. N.

Чеканов Михаил Николаевич, кафедра госпитальной и детской хирургии лечебного факультета

630091 г. Новосибирск, ул. Красный проспект, 52

Mikhail N. Chekanov,department of hospital and children surgery

630091 Novosibirsk, Krasniy prospekt, 52

ВерещагинЕ. И.VereshchaginE. I.

Верещагин Евгений Иванович, кафедра госпитальной и детской хирургии лечебного факультета

630091 г. Новосибирск, ул. Красный проспект, 52

Evgeni I. Vereshchagin, department of hospital and children surgery

630091 Novosibirsk, Krasniy prospekt, 52

630087 Novosibirsk, Nemirovich- Danchenko str., 130

ПешковаИ. В.PeshkovaI. V.

Пешкова Инесса Викторовна, кафедра госпитальной и детской хирургии лечебного факультета

630091 г. Новосибирск, ул. Красный проспект, 52

Inessa V. Peshkova, department of hospital and children surgery

630091 Novosibirsk, Krasniy prospekt, 52

630087 Novosibirsk, Nemirovich- Danchenko str., 130

ПолякевичА. С.PolyakevichA. S.

Полякевич Алексей Станиславович, кафедра госпитальной и детской хирургии лечебного факультета

630091 г. Новосибирск, ул. Красный проспект, 52

Aleksey S. Polyakevich, department of hospital and children surgery

630091 Novosibirsk, Krasniy prospekt, 52

ФГБОУ ВО Новосибирский Государственный медицинский университет Минздрава России; ГБУЗ НСО «Государственная Новосибирская областная клиническая больница»; ФГБУ Национальный медицинский исследовательский центр им. академика Е. Н. Мешалкина Министерства здравоохранения Российской ФедерацииРоссияNovosibirsk State Medical University Ministry of Healthcare of Russia; Novosibirsk State Regional Clinical Hospital; Meshalkin National Medical Research CenterRussian FederationФГБОУ ВО Новосибирский Государственный медицинский университет Минздрава России; ГБУЗ НСО «Государственная Новосибирская областная клиническая больница»РоссияNovosibirsk State Medical University Ministry of Healthcare of Russia; Novosibirsk State Regional Clinical HospitalRussian FederationГБУЗ НСО «Государственная Новосибирская областная клиническая больница»РоссияNovosibirsk State Regional Clinical HospitalRussian FederationФГБОУ ВО Новосибирский Государственный медицинский университет Минздрава РоссииРоссияNovosibirsk State Medical University Ministry of Healthcare of RussiaRussian FederationФГБОУ ВО Новосибирский Государственный медицинский университет Минздрава РоссииРоссияNovosibirsk State Medical University Ministry of Healthcare of Russia; Novosibirsk State Regional Clinical HospitalRussian Federation202131082021167581Copyright © Дробязгин Е.А., Чикинев Ю.В., Архипов Д.А., Митько Н.И., Чеканов М.Н., Верещагин Е.И., Пешкова И.В., Полякевич А.С., 20212021Дробязгин Е.А., Чикинев Ю.В., Архипов Д.А., Митько Н.И., Чеканов М.Н., Верещагин Е.И., Пешкова И.В., Полякевич А.С.Drobyazgin E.A., Chikinev Y.V., Arkhipov D.A., Mit’ko N.I., Chekanov M.N., Vereshchagin E.I., Peshkova I.V., Polyakevich A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nogr.org/jour/article/view/1679

Цель исследования — оценка результатов туннельных операций при подслизистых опухолях пищевода и ахалазии кардии.

Материал и методы

Материал и методы. Туннельные операции за период с 2017–2020 годы выполнены 80 пациентам в возрасте от 15 до 72 лет (мужчин — 34; женщин — 46). Показаниями к операции были: ахалазия кардии у 53, субэпителиальные опухоли у 27.

Результаты

Результаты. Во время проведения вмешательства осложнения возникли у 22 пациентов. Среди осложнений: карбоксиперитонеум у 16, карбокситоракс у 2, перфорация слизистой оболочки пищевода у 2, кровотечение умеренной интенсивности у 2. Основная масса осложнений (20) была у пациентов с ахалазией пищевода. Осложнения послеоперационного периода были у двух пациентов, оперированных по поводу ахалазии пищевода (кровотечение и гематома, некроз слизистой оболочки пищевода). Оба осложнения устранены с использованием консервативных методов. Результаты вмешательств оценены в сроки от 1 месяца до 3 лет. Нарушений пассажа пищи через кардию не выявлено. Пациенты, оперированные по поводу подслизистых опухолей пищевода жалоб не предъявляли. Основной жалобой пациентов после миотомии была изжога. При эндоскопическом исследовании эрозивный рефлюкс эзофагит (А-С) был выявлен у 18 пациентов.

Заключение

Заключение. Туннельные эндоскопические вмешательства у пациентов с ахалазией пищевода и подслизистыми опухолями являются высокоэффективными и малотравматичными, позволяя относительно безопасно восстановить проходимость кардии, удалить субэпителиальное новообразование. Проблема гастроэзофагеального рефлюкса после пероральной эндоскопической миотомии требует дальнейшего накопления данных, для выработки оптимальной тактики. Сдерживающим фактором для выполнения данных операций является материально- техническое оснащение лечебных организаций и отсутствие обученных специалистов.

The aim of the study is the evaluation of results of endoscopic tunnel interventions in submucosal tumors and achalasia.

Material and methods

Material and methods. Endoscopic tunnel interventions during 2017–2020 years were performed in 80 patients (34-men, 46-women). The duration of the age ranged from 15 to 72 years. The indications for interventions were: achalasia in 53, subepithelial tumors in 27.

Results

Results. During the intervention, complications occurred in 22 patients. Among the complications: carboxyperitoneum in 16 cases, carboxytorax in 2, esophageal mucosa perforation in 2, bleeding moderate intensity bleeding in 2. Most of the complications (20) were in patients with esophageal achalasia. Postoperative complications were observed in two patients operated for esophageal achalasia (bleeding and hematoma, esophageal mucosa necrosis). All patients were treated by using conservative methods. The results of the interventions were assessed in terms of 1 month to 3 years. There were no violations of food or liquid the passage through the cardia. Patients after operation for submucous tumors of the esophagus had no complaints. The main complaint of patients after myotomy was heartburn. Endoscopic examination revealed erosive reflux esophagitis (A-C) in 18 patients.

Conclusion

Conclusion. Tunnel endoscopic interventions in patients with esophageal achalasia and submucous tumors are highly effective and low-traumatic, allowing relatively safe restoration of the patency of the cardia and removal of the subepithelial neoplasm. The problem of gastroesophageal reflux after oral endoscopic myotomy requires further accumulation of data in order to develop optimal tactics. The limiting factor for the these operations performance is the material and technical equipment of medical institutions and the lack of trained specialists.

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The authors declare that there are no conflicts of interest present.