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[Jichi Medical School, 2004]


1. Visiting Jichi Medical School

2. ESD by Dr. Yamamoto

Endoscope Q-240À» ÁÖ·Î »ç¿ë. Ä¡·á³»½Ã°æ°ú °ü·ÃµÈ ´ëºÎºÐÀÇ º¸Á¶Àåºñ´Â Q-240°ú °°ÀÌ Ä¡·á¿ë ³»½Ã°æ¿¡ ÀûÇÕÇÏ°Ô °³¹ßµÈ´Ù. ESD¿Í °°ÀÌ º¹ÀâÇÑ ½Ã¼úÀ» Çϱâ À§Çؼ­´Â Áø´Ü¿ë ³»½Ã°æÀÎ XQ typeº¸´Ù´Â Q typeÀ» ¾²´Â °ÍÀÌ º¸´Ù ÁÁ´Ù. Q typeÀÇ ´ÜÁ¡Àº °¡°ÝÀÌ 10% °¡·® ºñ½Î°í ¿Ü°æÀÌ ¾à°£ -0.3mm Á¤µµ- ±½´Ù´Â °ÍÀÌ´Ù.
Electrosurgical unit ERBE VIO 300D¸¦ º¸À¯ÇÏ°í´Â ÀÖÁö¸¸ ¾ÆÁ÷Àº ÁÖ·Î ICC200À» ÀÌ¿ëÇÑ´Ù. MarkingÀº Soft cogulation 40W, circumferential cuttingÀº Endocutting 120W (coagulation effect 3), submucosal dissectionÀº Forced coagulation 25W¸¦ »ç¿ëÇÑ´Ù. Submucosal dissection¿¡ cuttingÀ» »ç¿ëÇÏÁö ¾Ê°í coagulationÀ» »ç¿ëÇÑ´Ù´Â Á¡ÀÌ Æ¯Â¡. ÀÌÀ¯´Â ... °¡´Â knife¸¦ »ç¿ëÇϹǷΠcoagulationÀ¸·Îµµ cuttingÀÌ °¡´ÉÇÏ°í ¹«¾ùº¸´Ùµµ bleedingÀÌ Àû°Ô ¹ß»ýÇϱ⠶§¹®ÀÌ´Ù. Dr. YamamotoÀÇ ESD´Â ÃâÇ÷ÀÌ ¸Å¿ì ÀûÀºµ¥ ±× ÀÌÀ¯ÁßÀÇ Çϳª°¡ ÀÌ·¯ÇÑ modeÀÇ ¼±Åÿ¡ ÀÖ´Â °Í °°´Ù.
knife Olympus KD-10Q-1. È®ÀÎÇØ º¸Áö ¸øÇßÀ¸³ª µÎ °¡ÁöÀÇ knife°¡ Àִµ¥ ±× Áß¿¡¼­ °¡´Â °ÍÀ» ÀÌ¿ëÇÑ´Ù°í ÇÑ´Ù. ¾Æ¸¶ ÀÌ modelÀÌ °¡´Â knifeÀÎ °Í °°´Ù. MTW»çÀÇ Á¦Ç°¿¡ ºñÇÏ¿© knifeÀÇ ±æÀÌ°¡ ª±â ¶§¹®¿¡ microscopic perforationÀÇ À§ÇèÀÌ °ÅÀÇ ¾ø´Ù.
injector Olympus NM-200L-0423. ±æÀÌ 4 mm, 23G needleÀ» °¡Áø modelÀÌ´Ù.
hot biopsy forcep Pentax»çÀÇ OD-D3 CE 09-197°ú Olympus FD 410LRÀÇ µÎ °¡Áö¸¦ »ç¿ë. Olympus´Â head°¡ Å« ¹Ý¸é ±æÀÌ°¡ ª±â ¶§¹®¿¡ Àß »ç¿ëÇÏÁö ¾Ê°í Olympus Á¦Ç°À» ¼±È£
conventional cap (hood) Fujinon¿¡¼­ ½ÃÆÇÁßÀÎ narrowed tipped capÀ» »ç¿ëÇϱ⵵ ÇÏÁö¸¸ Áַδ Olympus»çÀÇ D-201-11804 (¿Ü°æ 11.8mm, µ¹ÃâºÎ ±æÀÌ 4mm, soft type)À» ÀÌ¿ëÇÑ´Ù. 2 mm Â¥¸®¸¦ »ç¿ëÇÏ´Â ÁÙ ¾Ë¾Ò´Âµ¥ Ç×»ó 4 mm ¸¦ »ç¿ëÇÏ°í ÀÖ¾ú´Ù. 2 mm´Â ³»½Ã°æ°ú º´¼Ò¿ÍÀÇ °Å¸®°¡ ³Ê¹« °¡±õ±â ¶§¹®.
ÀÌ ¸ðµ¨µµ ¹°·Ð Q240¿¡ ¸Âµµ·Ï µÇ¾îÀÖ´Ù. ¾Õ¼­ ¾ð±ÞÇÑ ¹Ù¿Í °°ÀÌ Ä¡·á³»½Ã°æ °ü·Ã µµ±¸´Â ´ëºÎºÐ Q type¿¡ ÀûÇÕÇϵµ·Ï designµÇ¾î ÀÖ´Ù. »ç½Ç Dr. Yamamoto´Â capÀ» ¸Å¿ì À¯¿ëÇÏ°Ô »ç¿ëÇÑ´Ù. À߶ó¾ß ÇÏ´Â ºÎÀ§·ÎºÎÅÍ Àû´çÇÑ °Å¸®¸¦ È®º¸Çϱâ À§Çؼ­ capÀÇ ¿ªÇÒÀº ¸Å¿ì Å©´Ù. capÀÌ ¾øÀÌ needle knife¸¦ ÀÌ¿ëÇÏ¿© ESD¸¦ ÇÑ´Ù´Â °ÍÀº ¸Å¿ì ¹«¸ðÇØ º¸ÀδÙ. capÀ» »ç¿ëÇÏÁö ¾Ê°í ÀÚ¸¦ ¼ö ¾ø´Â ºÎÀ§°¡ ³Ê¹«³ª ¸¹±â ¶§¹®ÀÌ´Ù. ¹Ý¸é IT-knife¸¦ ÀÌ¿ëÇÑ ¹æ¹ý¿¡¼­´Â blindÇÏ°Ô ÀÚ¸¦ ¼ö ÀÖ´Â ¿©Áö°¡ Àֱ⠶§¹®¿¡ cap¾øÀÌ ½Ã¼úÇϱⰡ ºñ±³Àû ½±´Ù.
narrow tipped cap (hood) Yamamoto ¼±»ýÀÌ °³¹ßÇÑ capÀÌ´Ù. »óºÎÀ§Àå°ü¿ëÀº Fujinon DH-15GR, ÇϺÎÀ§Àå°ü¿ëÀº DH-16CR. tip openingÀÇ diameter´Â DH-15GR°ú DH-16CR ¸ðµÎ 7 mmÀÌÁö¸¸ ¿Ü°æÀº DH-15GRÀº 12.2 mm, DH-16CRÀº 16 mm ÀÌ´Ù. ´ç¿¬È÷ single use onlyÀÓ. sterilizationµÇ¾î ÀÖÁö ¾ÊÀº »óÅ·ΠÆǸŵǹǷΠ»ç¿ëÀü ¼Òµ¶À» ÇØ¾ß Çϴµ¥ EO gas ¼Òµ¶°ú glutaraldehyde´Â »ç¿ëÇÒ ¼ö ÀÖÀ¸³ª autoclavingÀº ¾ÈµÊ.
gauze °Ëü °íÁ¤ ÈÄ »ç¹«¿ë ÀÚ¸¦ »ç¿ëÇؼ­ °ËüÀÇ Å©±â¸¦ ÃøÁ¤ÇÏÁö ¾Ê°í, Á¦µµ¿ë ȤÀº °ø¾÷¿ëÀÎ º¸´Ù Á¤È®ÇÑ gauze¸¦ ÀÌ¿ëÇÏ¿© Å©±â¸¦ ÃøÁ¤

3. Yamamoto¹ýÀÇ ÀåÁ¡ - ´Ù¸¥ ¹æ¹ý°úÀÇ Â÷ÀÌÁ¡À» Áß½ÉÀ¸·Î

4. Double balloon enteroscopy by Dr. Yamamoto


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