内镜下OTSC系统处理腹腔镜胃癌根治术后吻合口漏的临床疗效分析  

Clinical efficacy analysis of endoscopic OTSC system in treating anastomotic leakage after laparoscopy-assisted gastrectomy for gastric cancer

作　　者：张杰 马贤纵 陈敬芳 周垚 张明杰 杜峻峰 金鹏 盛剑秋 王昕 谢惠 ZHANG Jie;MA Xianzong;CHEN Jingfang;ZHOU Yao;ZHANG Mingjie;DU Junfeng;JIN Peng;SHENG Jianqiu;WANG Xin;XIE Hui(Department of Gastroenterology,the seventh Medical Center of PLA General Hospital,Beijing 100700;Medical School of Chinese PLA;Outpatient Department of Longpan Middle Road,General Hospital of PLA Eastern Theater Command;31690 Army Hospital;Department of General Surgery,the Seventh Medical Center of PLA General Hospital,China)

机构地区：[1]中国人民解放军总医院第七医学中心消化内科,北京100700 [2]解放军医学院 [3]东部战区总医院龙蟠中路门诊部 [4]31690部队医院 [5]中国人民解放军总医院第七医学中心普通外科

出　　处：《胃肠病学和肝病学杂志》2023年第5期488-492,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：军事医学创新工程(18CXZ027);国家自然科学基金(81870393、81571563)。

摘　　要：目的探讨内镜下OTSC系统在处理腹腔镜胃癌根治术后吻合口漏中的应用及疗效。方法选择2017年1月至2019年6月经OTSC治疗的3例胃癌根治术后食管吻合口漏患者为研究对象,男2例,女1例。所有患者在接受内镜操作前均进行了有效的抗感染治疗、通畅的引流措施及足够的营养支持。利用内镜下OTSC系统处理吻合口漏,包括食管-空肠吻合口漏1例,食管-残胃吻合口漏2例。结果OTSC治疗距首次手术时间分别为45 d、27 d、28 d,漏口直径分别为8 mm、10 mm、2 mm,每例患者均使用1枚OTSC夹,OTSC系统操作时间分别为20 min、12 min、11 min,术中确认成功封堵漏口共2例,虽然另外1例未完全闭合漏口,但通过内科保守治疗后痊愈。总住院时间分别为74 d、48 d、22 d。随访时间分别为18个月、34个月、6个月,3例患者已恢复经口进食,目前均无瘤存活,无术中出血、迟发性出血、术后吻合口狭窄等并发症。结论使用OTSC治疗胃癌根治术后食管吻合口漏安全、微创、可靠,不足之处费用较高,特殊部位的操作对于内镜医师的经验要求较高,推荐在有经验的专科中心推广应用。Objective To explore the application and effect of over-the-scope-clip(OTSC)system in the treatment of anastomotic leakage after laparoscopy gastrectomy.Methods From Jan.2017 to Jun.2019,three patients with esophageal anastomotic leakage after laparoscopic gastric cancer surgery were enrolled into the present study,including two males and one female.With the confirmed diagnosis of anastomotic leakage,three patients firstly received effective anti-infection treatment,unobstructed drainage measures and adequate nutritional support,then they underwent endoscopic operation of OTSC system for anastomotic leakage,including one case of esophagojejunostomy and two cases of esophagogastrostomy.Results The time between OTSC treatment and the initial operation was 45 d,27 d and 8 d,and the diameter of leakage was 8 mm,10 mm and 2 mm,respectively.One OTSC clamp was used in each patient,and the operation time of OTSC system was 20 min,12 min and 11 min,respectively.Two patients were confirmed to have successfully blocked the fistula during the operation.The other patient recovered after conservative treatment of internal medicine.The total length of hospitalization was 74 d,48 d and 22 d,respectively.Follow-up time was 18 months,34 months and 6 months,respectively.There were no complications of intraoperative bleeding,delayed bleeding and postoperative anastomotic stenosis,etc.All the three patients survived without recurrence of cancer and recovered from oral feeding.Conclusion It is safe,minimally invasive and reliable to use OTSC in the treatment of esophageal anastomotic leakage after laparoscopic gastric cancer surgery.The disadvantages of OTSC are expensive medical cost,and the operation requires a more experienced endoscopists.It is recommended to use OTSC in experienced specialized centers.

关 键 词：OTSC系统 腹腔镜手术 胃癌 吻合口漏 

分 类 号：R571[医药卫生—消化系统]