美司钠在食管内镜黏膜下剥离技术的应用进展  

Application of MESNA in endoscopic submucosal dissection for esophageal diseases

作　　者：黄欢 蔡晓敏 程烨夏子 蓝幼珍 张杰希 伍齐鸣 陈素玉[2] 施宏[2] Huan Huang;Xiao-Min Cai;Ye-Xia-Zi Cheng;You-Zhen Lan;Jie-Xi Zhang;Qi-Ming Wu;Su-Yu Chen;Hong Shi(Department of Clinical Medicine,Fujian Medical University,Fuzhou 351018,Fujian Province,China;Department of Gastrointestinal Endoscopy,Fujian Cancer Hospital,Fujian Medical University Cancer Hospital,Fuzhou 350014,Fujian Province,China)

机构地区：[1]福建医科大学临床医学部,福建省福州市351018 [2]福建医科大学附属肿瘤医院内镜科,福建省福州市350014

出　　处：《世界华人消化杂志》2018年第28期1623-1627,共5页World Chinese Journal of Digestology

基　　金：福建省卫生计生中青年骨干人才培养项目;No.2017-ZQN-16~~

摘　　要：随着消化内镜技术的飞速发展,食管早期癌及癌前病变、平滑肌瘤、贲门失弛缓症、甚至纵隔病变等既往需要开胸手术治疗的病变可以经内镜治疗达到根治.内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)旨在整块切除消化道黏膜及黏膜下层病变,现已成为无淋巴结转移的食管早期癌及癌前病变的首选治疗方法.而隧道内镜技术则通过建立黏膜下隧道,更将消化内镜治疗范畴从黏膜、黏膜下层拓展到固有肌层乃至纵隔.无论ESD抑或隧道内镜,黏膜下剥离不可或缺,理想黏膜下注射液能够缩短黏膜下剥离时间,提高剥离效率.黏液溶解剂硫醇化合物美司钠黏膜下注射用以快速溶解结缔组织中二硫键,暴露血管,以利内镜黏膜下剥离,未来有望在内镜临床推广.With the development of digestive endoscopy, early esophageal carcinoma, esophageal leiomyoma, achalasia, and mediastinal lesions, which were previously treated by thoracoscopy or thoracotomy, may be treated by digestive endoscopy. Endoscopic submucosal dissection（ESD） can achieve en bloc resection of large gastrointestinal mucosal and submucosal lesions and has become the first-line treatment for early esophageal cancer and precancerous lesions without lymph node metastasis. Submucosal tunnel endoscopy has expanded endoscopic indications by establishing a submucosal tunnel, and it has been applied in esophageal lesions originating from the muscularis propia and even mediastinal tumors. An ideal submucosal fluid infusion may shorten dissection time during ESD or submucosal tunnel endoscopy. Selecting appropriate submucosal injection is one of the important factors for ESD success. Submucosal injections of sodium-2-mercaptoethanesulfonate can soften tissues and facilitate endoscopic submucosal dissection and is worthy of clinical promotion.

关 键 词：内镜黏膜下剥离术 隧道内镜 美司钠 化学辅助组织分离 黏膜下注射 

分 类 号：R655.4[医药卫生—外科学] R735.1[医药卫生—临床医学]