OTSC吻合夹在消化道瘘治疗中的应用效果  

Efficacy of over-the-scope clip for gastrointestinal fistula

作　　者：王革非[1] 汪志明[1] 吴秀文[1] 刁艳青[1] 赵允召[1] 任建安[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科解放军普通外科研究所,210002

出　　处：《中华胃肠外科杂志》2017年第1期79-83,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金资助项目（81571881）;南京军区科技创新面上项目（MS111）

摘　　要：目的 探讨OTSC吻合夹在消化道瘘治疗中的应用疗效。方法 回顾性分析2015年3月至2016年5月间南京军区南京总医院采用OTSC金属夹系统治疗的12例消化道瘘患者的临床资料，全组患者均在充分引流脓液，控制瘘口周围感染后，采用1枚OTSC吻合夹夹闭瘘口。结果 全组患者其中男性6例，女性6例，平均年龄（50.1±12.6）岁。均成功实施OTSC治疗，技术成功率达到100%，治疗过程中及治疗后未发生出血及梗阻等并发症。根据引流液内无消化液、未再出现腹腔感染或者消化道造影无造影剂外溢、CT检查无腹腔脓肿等综合评估，12例中有11例（91.7%）获临床治愈；平均随诊3月时间，未见消化道瘘复发。另1例腹腔镜袖状胃切除术后胃瘘患者使用OTSC吻合夹关闭瘘口后1周复发，经手术治愈。结论 OTSC吻合夹是消化道瘘的有效治疗手段，在瘘口周围脓腔充分引流、感染控制后实施OTSC是治疗成功的关键。Objective To explore the efficacy of over-the-scope clip （OTSC） in the treatment of gastrointestinal fistula.Methods Clinical data of 12 gastrointestinal fistula patients, including 3 internal fistula and 9 external fistula treated with OTSC in our institute from March 2015 to May 2016 were retrospectively analyzed. OTSC was performed when pus was drained thoroughly and intra-abdominal infection around gastrointestinal fistula was controlled, and each patient received one clip to close fistula.Results There were 6 female and 6 male patients with mean age of （50.1 ± 12.6） years. The successful rate of endoscopic closure was 100% without complications including bleeding and intestinal obstruction during and after OTSC treatment. According to comprehensive evaluation, including drainage without digestive juices, no recurrence of intra-abdominal infection, no overflow of contrast medium during digestive tract radiography, and CT examination without intra-abdominal abscess, clinical gastrointestinal fistula closure was 91.7% （11/12）. There was no recurrence of gastrointestinal fistula during 3 months of follow-up in 11 patients. In the remaining 1 case, the gastric fistula after laparoscopic sleeve gastrectomy recurred one week after OTSC treatment because of intra-abdominal infection surrounding fistula, and was cured by surgery finally.Conclusion The endoscopic closure treatment of OTSC for gastrointestinal fistula is successful and effective, and control of intra-abdominal infection around fistula with adequate drainage is the key point.

关 键 词：消化道瘘 OTSC吻合夹 内镜下闭合术 腹腔感染 

分 类 号：R619[医药卫生—外科学]