探讨内镜吻合夹在上消化道穿孔疾病中的应用价值  

Value of over-the-scope-clip for upper digestive tract perforation

作　　者：郑晓玲[1] 陈晓琼[1] 高丽影[1] 徐丽霞[1] 林海宁 钟世顺[1] 邓万银[1] 郑金辉[1] 梁玮[1] 

机构地区：[1]福建省立医院消化内镜中心,福州350001

出　　处：《中华消化内镜杂志》2017年第11期791-795,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜吻合夹（OTSC）在上消化道穿孔疾病诊治中的应用价值。方法选取2015年5月至2016年6月我院消化内镜中心就诊的陈旧性和新鲜性上消化道穿孔并采用OTSC进行内镜下缝合的患者13例，选用的OTSC夹型号均为11／6t，操作均由资深内镜医师完成。结果13例患者中新鲜性穿孔7例，均为胃黏膜下肿物内镜治疗术后医源性穿孔；陈旧性穿孔6例，其中自发性食管破裂2例，食管异物穿孔术后瘘2例，胃间质瘤腹腔镜术后瘘1例，食管癌术后吻合口瘘1例。13例病变中胃部穿孔8例（8／13），食管穿孔5例（5／13）；新鲜穿孔大小为4～30mm（平均15．3mm），陈旧性穿孔大小为5～10mm（平均7．8mm）。内镜操作时间，新鲜穿孔为6～27min（平均15．1min），陈旧性穿孔15—80min（平均42．3min），二者差异有统计学意义。技术成功率100％（13／13），临床成功率在新鲜穿孔为100％（7／7），陈旧性穿孔为50％（3／6）。13例患者均无特殊治疗，无特殊并发症。结论OTSC封闭上消化道穿孔是安全有效的，尤其对新鲜性穿孔疗效明显优于陈旧性穿孔。无明显炎症反应引起的纤维化时，可能是陈旧性穿孔置入OTSC的较好时机，〈30mm的病灶行OTSC成功率较高。OTSC自行脱落数较少，内镜下干预取出的必要性及时机仍需进一步探讨。Objective To explore the value of OTSC （over-the-scope-clip） for upper digestive tract perforation. Methods Thirteen patients with old and fresh upper digestive tract perforation, treated with an OTSC clip at the Department of Digestive Endoscopy from May 2015 to June 2016, were enrolled. All OTSCs were 11/6t, and all procedures were performed by experienced endoscopists. Results Seven cases of fresh perforation were iatrogenic after treatment for gastric submucosal tumor. Six cases of old perforation included 2 cases of spontaneous esophageal rupture, 2 fistula after operations for esophageal foreign body, 1 fistula after the operation for gastric stromal tumor, and 1 anastomotic fistula after esophagectomy. Eight cases of perforation occurred in stomach and 5 in esophageal. Fresh lesion sizes were from 4 to 30 mm （ average 15.3 mm） , old lesion sizes from 5 to 10 mm（average 7.8 mm）. OTSC＇s release time in fresh lesions was 6-27 min（ average 15.1 min）, that in old 15-80 rain（ average 42. 3 rain） with significant difference. Technical success rate was 100%（13/13） ,clinical success rate in fresh lesions was 100%（7/7）,and 50% （3/6） in old lesions. No patient had special treatment or complication. Conclusion OTSC is useful and safe for the treatment of upper digestive tract perforation, which is superior for fresh perforation than for the old. The perfect time to release OTSC for old perforation is when there is no obvious fibrosis caused by inflammation. The success rate is higher when the lesion size is smaller than 30 mm. Self-releasing of OTSC is rare. The necessity and the timing to take them out still needs further study.

关 键 词：食管穿孔 内窥镜检查 吻合术 治疗 

分 类 号：R656[医药卫生—外科学]