尼龙圈联合钛夹闭合术在内镜黏膜下剥离术中的价值  

Titanium clips combined with nylon cord for management of gastric defects during endoscopic submucosal dissection

作　　者：余福兵[1] 何夕昆[1] 郝玲[1] 盛娟[1] 伍瑞[1] 肖玉良[1] 丁惠芬[1] 吴丽娟[1] 张华杰[1] 张钰[1] 邹发海[1] 刀吉林[1] 

机构地区：[1]云南省第二人民医院消化科,云南昆明650021

出　　处：《中国内镜杂志》2013年第6期585-588,共4页China Journal of Endoscopy

基　　金：云南省自然科学基金资助项目(No.2009CD130);云南省教育厅科学研究基金资助项目(No.09C0294)

摘　　要：目的评价尼龙圈联合钛夹在内镜黏膜下剥离术中闭合切口的有效性和安全性。方法对内镜发现的胃黏膜下肿瘤(SMT)行EUS,对其中来源于固有肌层的SMT行内镜黏膜下剥离治疗。完整切除病变后,经内镜活检通道、直视下应用尼龙圈和钛夹缝合切口。观察术中尼龙圈联合钛夹缝合的成功率;术后内镜随访,检查尼龙圈联合钛夹缝合效果。结果 35例患者中病变位于胃底部24例,胃体部8例,胃窦部3例。3例发生穿孔,应用尼龙圈结合钛夹闭合术成功封闭,未转外科手术。35例完整缝合切口成功率100%,术后3个月均无发热腹痛等症状;平均随访5.3个月,创面均完整愈合。结论内镜下应用尼龙圈联合钛夹缝合内镜黏膜下剥离术中的切口是一种安全、有效的方法。【Objective】To evaluate the efficacy and safety of titanium clips combined with nylon cord in management of gastric defects during endoscopic submucosal dissection.【Methods】Patients with gastric SMT under endoscopic received EUS, and the SMT originated from the muscularis propria layer were studied, endoscopic submucosal dissection （ESD） for the removal of the SMT. After the operation, titanium clips combined with nylon cord were used to close the defects through endoscopic biopsy channel. The closure success rate with titanium clips combined with nylon cord was assessed. The patients were followed up endoscopically for evaluation of efficacy and safety of the procedure. 【Results】A total of 35 patients underwent endoscopic submucosal dissection. Postoperative perforation occurred in 3 cases, which received successful closure with titanium clips combined with nylon cord without surgical treatment. The overall success rate was 100% in 35 patients. Endoscopic followup was completed in all patients in average of 5.3 months. The clinical wound healing rate was 100%.No complications such as fever, abdominal pain were found in 3 months after the procedures. 【Conclusion】Application of Titanium clips combined with nylon cord during endoscopic submucosal dissection for gastric defects is a safe and effective technique.

关 键 词：内镜黏膜下剥离术 缝合技术 尼龙圈 钛夹 

分 类 号：R573[医药卫生—消化系统]