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

发布时间：2018-12-29 18:50

【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(P0.05)。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(P0.05);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(P0.05)。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]:Objective to evaluate the clinical value of single clamp endoscopy in the treatment of iatrogenic gastrointestinal mucosal defect. Methods from April 2015 to August 2016, the data of patients with large wounds caused by endoscopic submucosal dissection (endoscopic submucosal dissection,ESD) in digestive endoscopy center of our department were analyzed retrospectively. Among them, 42 cases were treated with single-clamp endoscope suture (study group), and 21 cases were left out (control group). The complications and wound healing were compared between the two groups. To evaluate the feasibility, safety and efficacy of single-clamp endoscopic leapfrog purse suture. Results there was no significant difference in wound diameter (1.4 卤0.8) cm, control group (1.2 卤1.0) cm, in the study group after ESD (P0.05). The patients in the study group were treated with an average of 4 ~ 6 metal clips and 1 ~ 2 nylon ropes. The wound suture was satisfactory, and the success rate was 100. 5 cases (5 / 42, 11.9%) had transient fever after operation. Abdominal pain and distension were found in 4 cases (4 / 42%). In the control group, 4 cases (4 / 21 卤19.0%) developed fever, 6 cases (6 / 21%, 28.6%) developed abdominal pain and abdominal distension, 2 cases (2 / 21 卤9.5%) postoperative wound bleeding, the difference between the two groups was statistically significant (P0.05). The hospitalization time of the study group was (4.52 卤1.27) days, the control group was (6.94 卤1.53) days, the difference was statistically significant (P0.05). The wound healed well after 1 month in the study group, and the scar formation was observed in the study group. Six patients with metal clip and nylon rope did not fall off. After 2 months, the wound was smooth and healed well. Only one patient with metal clip and nylon rope did not fall off. The patients in the control group were followed up for 1 month, 3 patients developed giant ulcer, and 2 months later, the ulcer surface of 1 patient was not healed well. Conclusion this method is safe and effective and can be widely used in clinic because of its low complication rate, short hospital stay and good wound healing.
【作者单位】：重庆市涪陵中心医院消化科;
【分类号】：R656

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