单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔  

Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract

作　　者：唐静[1] 杨丹[1] 沈文拥[1] 卢丹萍[1] 薛焱[1] 魏沙[1] 吴涛[1] 刘爱民[1] TANG Jing;YANG Dan;SHEN Wenyong;LU Danping;XUE Yan;WEI Sha;WU Tao;LIU Aimin(Department of Digestive Medicine,Fuling Central Hospital,Chongqing,408099,China)

机构地区：[1]重庆市涪陵中心医院消化科,重庆408099

出　　处：《第三军医大学学报》2020年第7期744-746,F0003,共4页Journal of Third Military Medical University

摘　　要：目的探讨单钳道内镜“8”字辅助缝合法在封闭消化道主动医源性穿孔中的临床价值。方法回顾性分析我科2018年11月至2019年7月38例术前经腹部CT及超声内镜等检查明确源于固有肌层深肌层、双向生长或向腔外生长,且直径>2 cm的上消化道黏膜下肿瘤(submucosal tumor,SMT),经内镜下全层切除术(endoscopic full-thick resection,EFTR)后形成主动医源性穿孔。采用我科自创的单钳道内镜“8”字辅助缝合法闭合创面,观察术中、术后并发症及术后随访情况等,评估其可行性、安全性和疗效。结果38例瘤体直径(2.6±0.8)cm,创面直径(3.8±0.5)cm,均成功完成穿孔修补,缝合时间(12.6±1.8)min,术后6例(15.8%)出现腹痛、腹胀,4例(10.5%)出现发热,其中3例为一过性发热,另1例缝合线未离断并发感染;无术中、术后严重并发症发生,无中转外科病例,术后住院时间5~9 d,术后1个月随访内镜创面均愈合良好,局部见线型瘢痕形成,3个月后复查内镜,创面愈合良好,无瘤体复发。结论单钳道内镜“8”字辅助缝合法能有效修补EFTR术后主动医源性穿孔,该方法安全、创伤小、费用低。Objective To investigate the clinical efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract following endoscopic full-thickness resection(EFTR).Methods We retrospectively analyzed the data of 38 patients with upper gastrointestinal submucosal tumors(SMT)with a diameter greater than 2 cm,which originated from the deep muscularis of the muscularis propria with bidirectional growth and were confirmed by preoperative abdominal CT and endoscopic ultrasonography in the Digestive Endoscopy Center of our hospital between November,2018 and July,2019.All these patients underwent EFTR of tumor,which resulted in iatrogenic perforation in the upper digestive tract.Single-clamp endoscopic 8-shaped suture was used to close the perforation,and the intra-and postoperative complications and postoperative follow-up data were analyzed to assess the feasibility,safety and efficacy of the approach.Results The patients had an average tumor diameter of 2.6±0.8 cm and a mean wound diameter of 3.8±0.5 cm.The perforation was successfully repaired in all the 38 cases with a mean suture time of 12.6±1.8 min.Six(15.8%)of the patients complained of abdominal pain and bloating after the operation,and 4(10.5%)patients had fever postoperatively,which was transient in 3 cases and as a result of infection due to failure of suture disconnection in the other case.None of the patients had serious intraoperative and postoperative complications or conversion to open surgery during the operation.The postoperative hospital stay was 5-9 d,and the endoscopic wounds healed well at 1 month after the operation in all the cases with visible scar formation.Follow-up endoscopy at 3 months postoperatively revealed good wound healing without signs of tumor recurrence.Conclusion Single-clamp endoscopic 8-shaped suture can effectively repair iatrogenic perforation after EFTR,which has good safety and less invasiveness with a low cost and a low risk of conversion to open surgery.

关 键 词：主动医源性穿孔 “8”字辅助缝合法 消化道内镜 

分 类 号：R573[医药卫生—消化系统] R615[医药卫生—内科学]