[1]唐静,卢丹萍,况晶,等.单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析[J].第三军医大学学报,2017,39(14):1493-1497.
 TANG Jing,LU Danping,KUANG Jing,et al.Single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic digestive tract mucosa defects: report of 42 cases[J].J Third Mil Med Univ,2017,39(14):1493-1497.
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单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第14期
页码:
1493-1497
栏目:
临床医学
出版日期:
2017-07-30

文章信息/Info

Title:
Single-channel endoscopic forceps leaping pouch suture for repairing iatrogenic digestive tract mucosa defects: report of 42 cases
作者:
唐静卢丹萍况晶杨丹吴涛杨美华刘爱民
重庆市涪陵中心医院消化科
Author(s):
TANG Jing LU Danping KUANG Jing YANG Dan WU Tao YANG Meihua LIU Aimin

Department of Gastroenterology, Fuling Central Hospital, Chongqing, 408000, China

关键词:
医源性胃肠黏膜缺损内镜金属夹尼龙圈
Keywords:
iatrogenic defect of gastrointestinal mucosa endoscope metal clip nylon rope
分类号:
R181.32;R573;R573.1
文献标志码:
A
摘要:

目的 探讨单钳道内镜跨越式荷包缝合法在封闭医源性胃肠黏膜缺损中的临床价值。方法 回顾性分析2015年4月至2016年8月我科消化内镜中心对胃肠道病变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)形成较大创面的患者资料,其中42例采用我科自创的单钳道内镜跨越式荷包缝合(研究组),余21例创面旷置(对照组),比较两组术后并发症发生情况及创面愈合情况,评估单钳道内镜跨越式荷包缝合法的可行性、安全性和疗效。结果研究组ESD术后创面直径(14±0.8)cm,对照组创面直径(1.2±1.0)cm,差异无统计学意义(P>005)。研究组单钳道内镜跨越式荷包缝合创面,每个患者平均使用金属夹4~6个,尼龙绳1~2个,创面缝合满意,成功率100%,术后5例(5/42,11.9%)出现一过性发热,4例(4/42,9.5%)出现腹痛、腹胀;对照组中4例(4/21,190%)出现发热,6例(6/21,28.6%)出现腹痛、腹胀,2例(2/21,9.5%)术后创面出血,两组差异有统计学意义(P<005);研究组住院时间(4.52±1.27)d,对照组住院时间(6.94±1.53)d,差异有统计学意义(P<005)。术后随访,研究组1个月后创面均愈合良好,可见疤痕形成,有6例患者金属夹及尼龙绳未脱落,2个月后复查内镜,创面光滑,愈合良好,仅1例患者金属夹及尼龙绳未脱落;对照组1个月后随访,3例患者创面形成巨大溃疡,2个月后复查内镜,其中1例患者溃疡面愈合较差。结论单钳道内镜跨越式荷包缝合法修补ESD术后较大创面术后并发症率低、住院时间短、创面愈合好;该法安全而有效,可广泛应用于临床。

Abstract:

ObjectiveTo evaluate the efficacy of singlechannel endoscopic forceps leaping pouch suture for repairing iatrogenic defect in the gastrointestinal mucosa. MethodsBetween April, 2015 and August, 2016, 63 patients underwent endoscopic submucosal dissection (ESD) in our Digestive Endoscopy Center, which caused extensive mucosal defects in the gastrointestinal tract. The wounds were repaired with singlechannel endoscopic leaping pouch suture in 42 patients (treatment group) and left exposed without suture in 21 patients (control group). The postoperative complications and wound healing were compared between the 2 groups to assess the feasibility, safety and efficacy of singlechannel endoscopic leaping pouch suture. ResultsThe mean diameter of the mucosal wounds were comparable  between the treatment and control group before operation (1.4±0.8 vs 1.2±1.0 cm, P>005). In the treatment group, singlechannel endoscopic leaping pouch suture used 4 to 6 metal clips and 1 or 2 nylon ropes in each operation, and a 100% success rate of wound closure was achieved after the operation. Five (11.9%) patients in the treatment group experienced transient fever after the operation and 4 (9.5%) reported abdominal pain and distension; in the control group, 4 (19%) patients experienced fever, 6 (28.6%) reported abdominal pain and distension, and 2 (9.5%) had postoperative wound bleeding, showing significant differences in the postoperative complications between the two groups (P<005).  The hospitalization time was significantly shorter in the treatment group than in the control group (4.52±1.27 vs 6.94±1.53 d, P<005). At 1 month after the operation, good wound healing and scar formation were observed in the treatment group, and the metal clips and nylon rope did not fall off in 6 patients; at 2 months after the operation, endoscopic examination revealed good wound healing with smooth surface in the treatment group, and the metal clips and nylon rope remained in only 1 case. In the control group, followup of the patients at 1 month showed massive ulcer in the wound in 6 patients, and endoscopy at 2 months still revealed poor healing of the ulcer in 1 patient. ConclusionSingle clamp endoscopy leaping pouch suture is safe and effective for repairing extensive gastrointestinal mucosal defects due to ESD and is associated with a low complication rate, a shorter hospital stay, and good wound healing.

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更新日期/Last Update: 2017-07-24