ESD和隧道技术经口内镜下肌切开术(POEM)  

ESD and tunneling technique: peroral endoscopic myotomy( POEM)

作　　者：谢静[1,2] 王东[1] 李兆申[1] Xie Jing Wang Dong Li Zhaoshen(Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China Digestive Endoscopy Center, Rocket Force General Hospital, Beijing 100088, China)

机构地区：[1]第二军医大学附属长海医院消化内镜中心,上海200433 [2]火箭军总医院消化内镜中心,北京100088

出　　处：《中华普外科手术学杂志（电子版）》2017年第2期174-176,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：经自然腔道内镜手术(NOTES)是指经人体自然腔道的内镜手术,近年来,NOTES技术已成为目前消化内镜微创技术发展的主要方向之一。然而目前在这一领域,临床的努力方向和研究的重点已经转移到制造病理性腔壁内和邻近腔壁的新的微创入路方法上,包括了更多常规介入性内镜诊疗操作。近来,有学者提出了新NOTES这一概念,其核心内容为经人体自然腔道,使用内镜进行手术,以取得病理组织、切除病变或解决梗阻、狭窄等问题,并不局限于进入腹腔。如消化内镜领域的经口内镜肌切开术(POEM)、黏膜下隧道内镜切除术(STER)、经口幽门肌切开术(POP)、内镜黏膜下剥离术(ESD)、内镜下全层切除术(EFTR)等,被称作new NOTES或near NOTES。其中POEM作为一项较新的NOTES技术,自2010年出现以来发展较为迅速,以黏膜下隧道技术和肌切开术为其基本技术,在新NOTES中应用较为广泛,治疗效果较确切,在贲门失弛症手术治疗上已可作为一线治疗的选择。本文就目前POEM的发展进行综述。NOTES（natural orifice transluminal endoscopic surgery,NOTES）has become one of the most important techniques for minimally invasive endoscopic surgery in recent years.However,in this field,the focus of clinical efforts and research has shifted to the new minimally invasive approach via pathological cavity wall and adjacent cavity wall,including more conventional endoscopic interventional procedures.Recently,the concept of new NOTES or near NOTES is proposed,which is endoscopic surgery through natural orifice to obtain pathological tissue,remove the lesion or solve obstruction,stenosis,such as peroral endoscopic myotomy（POEM）,submucosal tunneling endoscopic resection（STER）,peroral pylorotomy（POP）,endoscopic submucosal dissection（ESD）endoscopic full-thickness resection（EFTR）.POEM as a new NOTES technique based on ESD and submucosal tunneling,was rapidly developed and widely used since 2010,which has been available as first-line treatment for cardia achalasia.In this paper,the development of POEM is reviewed.

关 键 词：食管失驰症 内窥镜检查 内镜下黏膜剥离术 

分 类 号：R656[医药卫生—外科学]