clinendoКлиническая эндоскопияFilin’s Clinical endoscopy2415-7813"Global Media technology" Ltdclinendo-484Research ArticleКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL OBSERVATIONSЭндоскопическая туннельная резекция подслизистых опухолей в желудке. Новая операция - новые проблемыSubmucosal tunneling endoscopic resection for the treatment of submucosal gastric tumor: new technic - new problemsСидороваА. Н.SidorovaA. N.noemail@neicon.ruТкаченкоО. Б.TkachenkoO. B.noemail@neicon.ruЩербаковА. М.SherbakovA. M.noemail@neicon.ruБелоглазоваО. В.BeloglazovaO. V.noemail@neicon.ruГринкевичМ. В.GrinkevichM. V.noemail@neicon.ruПетрикЮ. В.PetrikU. V.noemail@neicon.ruФГБУ НИИ онкологии им. Н.Н. ПетроваState Research Institute of Oncology named after N.N. Petrov20170912202516469Copyright © Сидорова А.Н., Ткаченко О.Б., Щербаков А.М., Белоглазова О.В., Гринкевич М.В., Петрик Ю.В., 20252025Сидорова А.Н., Ткаченко О.Б., Щербаков А.М., Белоглазова О.В., Гринкевич М.В., Петрик Ю.В.Sidorova A.N., Tkachenko O.B., Sherbakov A.M., Beloglazova O.V., Grinkevich M.V., Petrik U.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://clinendo.elpub.ru/jour/article/view/484

Эндоскопическая туннельная резекция является сравнительно новым методом лечения подслизистых образований верхних отделов желудочно-кишечного тракта. По данным мировой литературы, осложнения этих операций относительно редки и сопряжены преимущественно с развитием пневмоторакса, пневмоперитонеума и подкожной эмфиземы. Эти проблемы связаны непосредственно с техникой выполнения манипуляции и являются прогнозируемыми. В своей практике мы столкнулись с осложнением, развившемся у пациентки 60-ти лет при удалении подслизистой опухоли желудка (шваннома), размерами 30 мм, методом эндоскопической туннельной резекции. Во время формирования туннеля произошел разрыв слизистой над ним, который удалось герметично устранить при помощи эндоскопических клипс. Далее, входе извлечения резецированного новообразования произошел полностенный разрыв устья пищевода и глотки. Попытки эндоскопического укрытия дефекта были безуспешны. Устранение разрыва стенки выполнено путем открытого хирургического вмешательства. Пациентка выписана из стационара в удовлетворительном состоянии на 21-е сутки после операции. При изучении публикаций, посвященных этой теме, эндоскопическая туннельная резекция подслизистых опухолей верхних отделов желудочно-кишечного тракта представляется достаточно безопасной методикой. Однако, ввиду ее относительной новизны и отсутствия большого мирового опыта, не всегда удается предусмотреть все возможные трудности. Поэтому такие операции необходимо выполнять в условиях стационара с широкими возможностями борьбы с непредвиденными осложнениями.

Submucosal tunneling endoscopic resection (STER) is a comparatively new method of treatment of submucosal masses of the upper gastrointestinal tract. According to the world literature, complications of these operations are relatively rare and primarily associated with development of pneumothorax, pneumoperitoneum, and subcutaneous emphysema. These problems are directly related to the technique of manipulation and predictable. In our practice we had a complication that developed in a 60 years old female, during removal 30 mm size submucosal gastric tumor (schwannoma) by STER technic. During the formation of the tunnel, the covering mucosa was ruptured. It was closed by endoscopic clipping. During the extraction of the resected tumor the fullthickness rupture of the upper part of esophagus and hypopharynx had occurred. The attempts of endoscopic suturing of the defect were unsuccessful and the open surgery was applied. The patient was discharged from the hospital in good health at the 21th day after the operation. In the publications on this topic, submucosal tunneling endoscopic resection of submucosal lesions of the upper gastrointestinal tract is quite a safe procedure. However, in view of its relative novelty and no large international experience, it is not always possible to foresee all possible difficulties. Therefore, these operations must be performed in a hospital with ample opportunities to deal with unforeseen complications.

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The authors declare that there are no conflicts of interest present.