Doctor‘s cardChen Weiqing: chief physician, MD, master tutor, director of Department of Gastroenterology, Chongqing Cancer Hospital, Chongqi
Chen Weiqing: chief physician, MD, master tutor, director of Department of Gastroenterology, Chongqing Cancer Hospital, Chongqing cancer institute director of the Department of digestive cancer early diagnosis and minimally invasive treatment center, deputy director of the Chongqing Municipal Department of Gastroenterology, quality control center. Chongqing branch of the Chinese Medical Association of digestive endoscopy Specialized Committee Committee, Chongqing branch of the Chinese Medical Association of digestive endoscopy endoscopic ultrasound study group, Specialized Committee, Chongqing branch of the Chinese Medical Association digestion of gastrointestinal and digestive diseases study group deputy leader. Department of Gastroenterology, engaged in clinical teaching and research work for many years, the clinical diagnosis and treatment of gastrointestinal hemorrhage, severe pancreatitis, cirrhosis and its complications and inflammatory bowel disease have more in-depth research, especially in liver and pancreas and gastrointestinal diseases such as endoscopic diagnosis and endoscopic interventional treatment.
The gap between domestic and foreign cancer survival depends on the technology to close
Text: Xiang Jiao
With the rapid development of China's medical technology and equipment, China's cancer in the diagnosis, treatment and other aspects of the technical level, and the developed countries almost. But in fact, 5 years survival rate of cancer patients in China is only about $30%, while the United States is up to 60%. Why the gap so big? Department of Gastroenterology, Chongqing Cancer Hospital director Chen Weiqing very aptly: discovered too late!
In the case of cancer of the digestive tract, the highest rate of early detection of cancer in China is only about 20%, while Japan's data is 80%, South Korea reached 70%. Because of the lack of early detection of the mechanism and awareness of cancer, many patients find cancer, it is already in the advanced stage, the best opportunity for treatment has been lost, the chance of survival naturally greatly reduced. However, with the development of digestive endoscopy technology, all this is changing.
New digestive endoscopy diagnosis and treatment technology management requirements more stringent
By the end of 2015, led by the Chongqing municipal health and Family Planning Commission, the municipal cancer prevention and control office and the municipal cancer hospital is responsible for the implementation of the city in 2015 the city's early diagnosis and early treatment of cancer project officially started. Combined with this opportunity, in January 2016, Chen Weiqing led the establishment of the cancer hospital in the city of the early diagnosis of digestive tract cancer and minimally invasive treatment center.
Digestive tract early cancer diagnosis and minimally invasive treatment center of cancer hospital was strictly implemented by the national health and Family Planning Commission in December 27, 2013 issued by the "digestive endoscopy diagnosis and treatment technology management standards (2013 Edition)". Although the new standard of high risk, intends to carry out the process is complex and difficult, according to medical institutions, endoscopy grade four surgical management of the physician and equipment are made more stringent requirements, but in Chen Weiqing's view, this is not a bad thing, the opposite is more conducive to the early screening of digestive system cancer.
Digestive endoscopy will turn to mucosal surgeon
At present in the clinic, the digestive system is generally divided into parts. For example, the liver, pancreas, intestines, stomach, esophagus diseases belong to the digestive medicine; stomach, small intestine, colon belongs to gastrointestinal surgery; and liver, pancreas belongs to the Department of Hepatobiliary Surgery; esophagus belongs to Department of thoracic surgery. However, with the rapid development of technology of diagnosis and treatment of gastrointestinal endoscopy, such as knife, stapler, stapler, hemostatic device and other parts of the development of more and more, the digestive endoscopic diagnosis and surgical technique become more and more small.
As a result, doctors in the digestive system may gradually be divided into mucosal and serosal surgeons. The traditional surgeon is the serosal surgeon, that is, they are skin into the chest, abdominal surgery. The digestive endoscopy is a mucosal surgeon, because the endoscope through the mucosa into the chest, abdominal surgery.
Digestive endoscopy magic (bid)
Digestive endoscopy is the main method for early diagnosis of digestive tract tumors. But now the technology of gastrointestinal endoscopy in recent years there are many new developments, including endoscopic technology, colonoscopy technology, endoscopic technique, endoscopy technique, endoscopic ultrasound technology, capsule endoscopy, laparoscopy, choledochoscopy of mother babyscope technology, technology of diagnosis and treatment technology. Therefore, its function is not only to check the traditional gastroscopy and colonoscopy intubation, more for the diagnosis and treatment of early carcinoma of digestive system.
Early diagnosis of early cancer and precancerous lesions
Previously only ordinary white light inspection, has now developed to the electronic staining endoscopy, chemical staining, magnifying endoscopy and other fine inspection. A number of early gastrointestinal tumors and precancerous lesions can be detected by regular fine screening.
1, electronic staining endoscopy
Before the digestive endoscopic diagnosis of early cancer is the common white light endoscopy, and now can be dyed with special optical (NBI, Blue Aurora), electronic endoscopy staining, such as OLYMPUS NBI, Fuji FICE, intelligent chromoendoscopy Blue Aurora, Pentax I-Scan enhanced endoscopy, can significantly improve the detection rate of gastrointestinal mucosal lesions. Provides a powerful weapon for early cancer screening.
Compared with the ordinary white light endoscopy, staining endoscopy can clearly observe the fine structure of the lesion site, clear the location and nature of the early lesions, so that the early tumor nowhere to hide". At the same time, under the guidance of the doctor, the doctor can accurately perform the endoscopic surgical treatment of the disease.
2, chemical staining
Can also use chemical dyes to detect early cancer. These include stain for iodine of esophagus, stomach and colon for indigo carmine, found for esophageal and gastric intestinal metaplasia, methylene blue, used to display the surface structure covered by columnar epithelium of the esophagus dilute acetic acid etc.. These methods not only help to detect early cancer, but also contribute to the detailed description of the lesions.
3, magnifying endoscopy
Chen Weiqing introduced, in addition to the above two kinds of checks, as well as magnifying endoscopy. Endoscopy in general will not be significantly enlarged lesions, but the examination can be enlarged to focus a few times, one hundred times, plus the lesions after dyeing, it can be observed from different angles, gland lesions and vascular changes of pipe opening type. In general, the early cancer of the glandular tube opening has changed, not only disorder, but not standardized, as well as new tumor vascular proliferation, which is conducive to the diagnosis of the disease.
The above 3 kinds of checks are called fine inspection, which is one of the core of precision medicine. After careful examination, the endoscopic findings of the lesion, the purpose of accurate biopsy or endoscopic resection specimens sent to pathological examination, more conducive to early diagnosis of cancer. General ordinary white light endoscopy + painless gastroscopy, almost 500 yuan, while doing a fine check was only about $1000, the accuracy of screening is completely different. So, as long as clinicians recommend careful examination, most patients are willing to accept.
Excision of early cancer can be removed under endoscope
In addition to the diagnosis of early cancer, digestive endoscopy can also be used for the treatment of early cancer. At present, with the development of technology of diagnosis and treatment of gastrointestinal endoscopy in gastrointestinal tract of the digestive system, once found in precancerous lesions such as dysplasia, polyps and early tumor resection, can be directly under the endoscope, so you can not use the traditional way of surgery, performed by endoscopic surgery minimally invasive, it is particularly important to integrity organ preserving. The most important thing is that early diagnosis and early treatment has a good prognosis.
Endoscopic diagnosis and treatment techniques include endoscopic esophageal mucosal dissection and endoscopic gastric mucosal dissection.
1, endoscopic mucosal resection EMR
This technique is a new technology developed in the past twenty years, which can be used for endoscopic resection of early gastrointestinal cancer, flat adenoma and submucosal tumor. From a technical perspective, once the discovery of severe atypical hyperplasia, or has been cancerous, but in the mucosa, or in the superficial layer of the mucosa, the use of EMR resection, so that the tumor will not be transferred.
2, endoscopic submucosal dissection ESD
This technology is a new technology developed in recent years. It may be the standard treatment for early cancer of digestive system in the future. It can be used for the treatment of superficial lesions of early gastrointestinal tract. In order to avoid the surgical operation and to retain the organs, the whole body is removed. Generally 2cm lesions within the use of EMR, 2cm above the use of ESD. Endoscopic resection of early gastrointestinal cancer is less invasive, faster recovery, and minimally invasive surgery compared with traditional surgery.
"Although these are the treatment of endoscopic treatment of 5 mm - 5 cm wide base polyps, but the polyps of 10 cm, I have done." Chen Weiqing said that even if the tumor infiltrated into the middle and lower layers of the mucosa, but as long as there is no metastasis, early colorectal cancer can still be combined with surgical treatment, and no chemotherapy after surgery. Early detection of colorectal cancer, compared with a diagnosis of advanced colorectal cancer, the prognosis is good.
Peel, tunnel: management cavity into the body operation without leaving a wound
Modern medical treatment to promote minimally invasive, but even if the laparoscope, thoracoscopy, spinal, arthroscopy and other minimally invasive surgery, will appear on the surface of small wounds. However, due to the special requirements of patients more and more, such as professional women, dancers, Ms. Amy, and so do not want to leave scar requirements, the above parts of the mucosal stripping, but also extends a lot of technology.
Chen Weiqing said that the human body has stomach, esophagus, vagina and other natural lumen, digestive endoscopy can enter the body through the natural lumen surgery, the appearance can not see any wounds. For example, submucosal tumor stripping technology, which is recognized as a global senior physicians digestion technology, the reason is that it can avoid the traditional surgery.
Again through the mouth through the tunnel endoscopic stromal tumor excision, it can treat submucosal tumors through hole tunnel in the form of the tumor to pull out, there is no mucosal defect. This technique can be used in any part of the body, such as the stomach, gallbladder, appendix, colon cancer.
Digestive endoscopy technology can also be changed into blood vessels surgery (bid)
The initial ultrasound technique was used to check for cracks in large steel, hull, and so on, which was later referred to the human body, such as abdominal ultrasound. But the abdominal ultrasound diagnosis efficiency is not high, the interference factors, such as weight, distance, will affect the effect.
However, endoscopic ultrasonography can overcome these difficulties and improve the diagnostic efficiency. Chen Weiqing played an analogy, said endoscopic ultrasound diagnosis and treatment technology, like Sun Wukong into the Iron Fan Princess body, through the stomach to see the biliary tract, liver, pancreas and other lesions. This will not only be able to see, from the viscera to the target only about 1 cm, but also easily guide puncture, injection, placement of stents, for the diagnosis and treatment of tumors and their complications.
Will soon add more high-tech and means
Although the above technology is in full swing, but some of the more high-end technology, such as the mouth of the endoscopic diagnosis and treatment of pancreatic duct, endoscopic bile duct biopsy, in Chongqing and even in the country, there are few hospitals in. It is understood that the mouth of the endoscopic diagnosis and treatment technology is currently only 5, 6 hospitals in Chongqing, only a handful of hospitals in the treatment. The only 1 hospitals in Chongqing are undergoing endoscopic biliary duct biopsy.
Chen Weiqing analysis, which is mainly associated with high technical requirements, expensive equipment, easy damage and other factors. Biliary and pancreatic duct diameter of about 3 mm lens inside the light soldering and the conduction system, the bending is easy to bad. A set of equipment costs about 200 thousand or more, and a set of equipment can do up to 5, 6 times on the broken, can not repair. Therefore, many of the new technology is now a lot of hospitals or not to carry out, or are losing money in doing.
However, with the rapid development of medical technology, will soon increase the number of appropriate technologies and means out.
The early diagnosis and treatment of carcinoma of digestive endoscopy go15 on the road
According to the data from 2015, nearly 1000 cases of patients with early cancer were found in Chongqing. Although this data does not meet the high level of the country, but at least a new breakthrough, but also means that the city's early cancer detection rate is gradually increasing.
But Chen Weiqing also said that the future of Gastroenterology in the Chongqing Cancer Hospital doctors should not only strive to become mucosal doctor, will also send the doctor specifically to learn and carry out interventional therapy, such as liver cancer, lung cancer, vascular bleeding, gastrointestinal bleeding, hepatic vascular vascular malformation, vascular bypass (TIPS). To this end, the new building will be built in a radiology intervention room, when the Department can carry out the examination and treatment of a wider range, will also provide services for more patients.
"The diagnosis of early carcinoma of digestive endoscopy go15 on the road, I'm afraid this life will not end, so I hope the younger generation to speed up the pace to keep up with." Chen Weiqing sincere words and earnest wishes to say.