Методики тракции опухоли во внутрипросветной эндоскопической хирургии пищеварительного тракта

Эндоскопическая резекция слизистой оболочки с диссекцией в подслизистом слое (ЭПД) в настоящее время является передовым методом лечения раннего рака верхних и нижних отделов пищеварительного тракта. Метод ЭПД позволяет удалять опухоли любых размеров единым блоком, в отличие от эндоскопической резекции слизистой оболочки (ЭРС), когда возможно en bloc удалять образования размером менее 20 мм. Несмотря на это преимущество, ЭПД сопровождается большим количеством перфораций и кровотечений, чем EMR. Сложная анатомическая локализация, тонкий мышечный слой стенки органа, фиброз подслизистого слоя и недостаточный опыт оперирующего эндоскописта— основные причины неполных резекций опухоли, развития осложнений и рецидивов.
Разработанные методики тракции опухоли при выполнении подслизистой диссекции позволяют увеличить долю резекции единым блоком и добиться радикальности. Нами представлен широкий арсенал различных методик тракции опухоли при выполнении ЭПД. Мы отметили как преимущества, так и недостатки тракционных методик в эндоскопической внутрипросветной хирургии.

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