| 抄録 |
Introduction: We developped safe endoscopic submucosal dissection (ESD) and laparoscopy endoscopy cooperative surgery (LECS) to perform en-bloc resection for tumors accompanied with firm fbrosis in submucosa(SM). Aims and methods: ESD was performed for 531 cases of tumor in 519 patients (male: female = 309:210; mean age, 67.0 years). Among these, 126 cases were accompanied with fibrosis. We analyzed these lesions in order to establish a safe en-bloc resection procedure. Results:ESD cases were divided into three groups, absent with fibrosis:type A, fibrosis due to benign causes:type B, and fibrosis due to SM cancer invasion:type C. We classified endoscopic findings of mild degree as B-1and C-1. moderate degree as B-2 and C-2, and screen-like firm fibrosis as B-3 and C-3. We performed en-bloc resection for 498 (93.8%) cases. And en-bloc resection rate as follows, type B-1: 44/47(94.5%), B-2:17/20(85.0%), B-3:13/21 (61.9%), type C-1:19/19(100%), C-2:4/5(80%), C-3:8/14(57.1%). The results of B-3, and C-3 were showing uncomfortable significantly. Recently, we designed safe technique by using endo-clips to prevent perforation in 2 cases with type B-3. Otherwise, in cases with more wide and firm fibrosis,en-bloc resection will become more difficult. From these reasons, we established LECS procedure to complete safe en-bloc resection with adequate surgical margin, and performed LECS for 4 cases of colorectal tumors.Conclusions: We improved ESD and its applied LECS procedure in order to achieve safe en-bloc resection for tumors accompanied with fibrosis. |
