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  • 1 Kaposi Mór Oktató Kórház Általános Mellkas- és Érsebészeti Osztály Kaposvár Pipacs u. 37. 7400
  • 2 Bács-Kiskun Megyei Kórház Belgyógyászat-Gasztroenterológia Kecskemét
  • 3 OMCH Kft. Kecskemét
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Az endoszkópos submucosus dissectio a tápcsatorna széles alapú, lap szerint terjedő elváltozásainak, minimálisan invazív, egy blokkban történő endoszkópos eltávolításának ígéretes új módszere. A szerzők jelen közleményükben sertésmodellen és betegeken két centrumban végzett endoszkópos submucosus dissectio összehasonlító vizsgálatának eredményét és a gyakorlati tapasztalatait mutatják be. Módszer: A kezdeti kompetencia megszerzése ex vivo erlangeni gyomormodelleken történt. Ezt követően összesen 15 különálló beavatkozást (három nyelőcső és 12 gyomor) végeztek öt altatott élő sertésen, váltott vizsgáló orvossal. A submucosalis aláoltást követően a Fujinone ball tip flush knife-ot használtak mind a bemetszéshez, mind a submucosalis dissectióhoz. Elemezték a komplett reszekciók arányát, az eltávolított szövetek méretét, a beavatkozás időtartamát és a szövődmények arányát. Ezenkívül a 2009–2012 közötti időszakban összesen 14 betegben végeztek humán endoszkópos submucosus dissectiót. Egy duodenum-, három gyomor- és 10 colorectalis beavatkozás történt, átlagosan 1,5 év utánkövetési időszakkal. Rögzítették a beavatkozások sikerét, az eltávolított szövetminta méretét, a recidívaarányt, a szövődményeket és a beavatkozások időtartamát. Eredmények: Az in vivo állatkísérletes modelleken a komplett reszekció aránya 87% (13/15), az eltávolított szövetdarabok átlagos mérete 29,4±19,5 cm2, a beavatkozások átlagos időtartama 136,2±26,8 perc volt. Négy esetben történt perforáció, amelyek közül hármat (20%) sikerült fémklipekkel megnyugtatóan zárni, egy nyelőcső-perforáció esetében azonban ez nem volt lehetséges és az állat halálát okozta. Minden vérzést sikerült a beavatkozások alatt teljes mértékben megszüntetni. A humán endoszkópos submucosus dissectio során a komplett reszekciók aránya 79% (11/14), a reszekátumok átlagos mérete 11,56±4,9 cm2, a beavatkozások áltagos időtartama 157±55 perc volt. Szignifikáns vérzést és perforációt két-két betegben (14%) észleltek. Minden szövődmény endoszkópos úton ellátható volt. Egy betegben észleltek lokális recidívát, amely miatt és a másik három inkomplett reszekátum esetében sebészi intervenció történt. Következtetés: Jelen prospektív tanulmány az endoszkópos submucosus dissectióval szerzett első hazai eredményeket és a beavatkozások során szerzett gyakorlati tapasztalatokat mutatja be. Az élő, altatott sertés modellen történő képzés a tanulási folyamat fontos eleme a humán beavatkozások megkezdése előtt. A flush knife használata a szerzők tapasztalata szerint rövidíti a műtéti időt és csökkenti a szövődmények (elsősorban a vérzés) gyakoriságát. Orv. Hetil., 2012, 153, 824–833.

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