内镜技术在肠瘘诊治中的应用  

Clinical application of endoscopic closure in the diagnosis and treatment of intestinal fistula

作　　者：张娟娟 汪志明 ZHANG Juan-juan;WANG Zhi-ming(Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]中国人民解放军东部战区总医院,中国人民解放军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2025年第3期304-308,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82170581)。

摘　　要：肠瘘是腹部手术后常见的并发症,容易引发腹腔感染、出血和多器官功能障碍等严重问题,且病程较长,治疗复杂。随着内镜技术的快速发展,内镜下早期闭合肠瘘成为可能,且相比传统手术治疗,内镜治疗具有创伤小、并发症少、操作简便等优点,成为治疗肠瘘的重要方法。常用的内镜治疗技术包括金属夹、支架置入、内镜缝合及组织密封剂等。肠瘘的治疗经历了从传统手术到内镜治疗的转变,内镜技术在微创治疗中的优势已被广泛认可。近年来,内镜治疗方法的不断创新,使得肠瘘治疗效果得到了显著改善。支架治疗是常用的技术之一,尤其是自膨胀金属支架(SEMS)在治疗肠瘘方面显示出高成功率和低并发症发生率。金属夹技术和内镜下缝合技术也具有良好的应用前景,尤其是OTSC金属夹在治疗消化道瘘方面效果显著。内镜治疗的关键在于根据病人的具体病情选择合适的治疗方法,病程较短且瘘口纤维化较少时,OTSC等技术能够达到较好的治疗效果。内镜技术的不断发展和优化为肠瘘的治疗提供了新的希望,未来仍需要通过更多临床研究来验证不同内镜治疗手段的长期效果及其在肠瘘治疗中的广泛应用。Intestinal fistula is a common complication after abdominal surgery,often leading to severe issues such as intraabdominal infections,bleeding,and multiple organ dysfunction.The condition typically has a prolonged course and complex treatment.With the rapid development of endoscopic technology,early endoscopic closure of intestinal fistulas has become possible.Compared with traditional surgical treatment,endoscopic treatment has the advantages of minimal trauma,fewer complications,and ease of operation,making it an important method for treating intestinal fistulas.Commonly used endoscopic treatment techniques include metal clips,stent placement,endoscopic suturing,and tissue sealants.The treatment of intestinal fistulas has evolved from traditional surgery to endoscopic therapy,with the advantages of endoscopic technology in minimally invasive treatment being widely recognized.In recent years,continuous innovations in endoscopic treatment methods have significantly improved the effectiveness of intestinal fistula treatment.Stent therapy is one of the commonly used techniques,especially self-expanding metal stents(SEMS),which have shown high success rates and low complication rates in the treatment of intestinal fistulas.Metal clip techniques and endoscopic suturing techniques also have good prospects,with the OTSC metal clip showing significant effectiveness in treating gastrointestinal fistulas.The key to endoscopic treatment is selecting the appropriate treatment method based on the patient’s specific condition.When the disease course is short and the fistula has minimal fibrosis,techniques such as OTSC can achieve good therapeutic results.The continuous development and optimization of endoscopic technology provide new hope for the treatment of intestinal fistulas,and further clinical research is needed to verify the long-term effects of different endoscopic treatment methods and their broad applications in the treatment of intestinal fistulas.

关 键 词：肠瘘 腹部手术 内镜治疗 金属夹 自膨胀金属支架 内镜缝合 组织密封剂 微创治疗 

分 类 号：R656.7[医药卫生—外科学]