摘要
目的探讨金属夹联合尼龙绳间断缝合术修补内镜下全层切除术（EFR）治疗后胃壁缺损的临床价值。方法回顾性分析2011年3—10月间复旦大学附属中山医院内镜中心行金属夹联合尼龙绳间断缝合术修补EFR治疗后胃壁缺损患者的临床资料，评价其可行性、安全性和疗效。结果共计14例患者．中位年龄49（32-63）岁。病变位于胃体5例，胃底8例，胃窦与胃体交界l例。病变大小为0．6～3．0cm。应用金属夹联合尼龙绳间断缝合术修补成功率100％（14／14），内镜下修补中位用时12（8-201min，无中转外科手术或腹腔镜手术病例。4例于治疗后1d出现腹部胀痛或隐痛．体温升高．其中2例经B超提示腹腔有少量积液，给予穿刺引流；4例均继续半卧位，持续胃肠减压和抗感染治疗1～3d后好转出院。术后14例均获随访，中位随访时间3（1～8）个月，2例创面金属夹和尼龙绳残留．给予内镜下异物钳取出，创面愈合好。结论金属夹联合尼龙绳间断缝合术修补EFR治疗后胃壁缺损安全而有效，可以成为临床上消化道缺损内镜下修复的方法之一。
Objective To study the value of the metal clips and endoloop snare for gastric wall defect after endoscopic full-thick resection （EFR）. Methods All the patients who underwent complete closure of gastric wall defect after endoscopic full-thick resection with metal clips and endoloop snare in the Endoscopy Center of Zhongshan hospital from March 2011 to October 2011 were retrospectively studied. The feasibility, safety, and efficacy were evaluated. Results Forteen patients were included in this study. The median age was 49 （32-63） years. Lesions located in the gastric body in 5 cases, the gastric fundus in 8 cases, and the gastric antrum and body junction in 1 case. The were diameter was 0.6-3.0 cm. Complete closure rate was 100% using this technique. The median repair time was 12 （8-20） min. No patients were converted to surgery or laparoscopic surgery. Four patients complained of abdomen pain with elevated body temperature, and uhrasonography showed minor peritoneal fluid in 2 cases, which were drained. These four cases were asked to maintain semi-reclining position and were put on fasting, continuous gastrointestinal decompression, and received antibiotics. They were discharged after 1-3 days. All the patients were followed up with a median time of 3 （1-8） months. Nylon and clips residual were removed endoscopically and the wound healing was satisfactory. Conclusion Metal clips and endoloop snare is safe and effective for the closure of gastric wall defect after EFR.
出处
《中华胃肠外科杂志》
CAS
2012年第3期280-284,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学青年基金（81101566）
上海市科委重大项目（09DZ1950102,10411962300,09411967100）
上海市卫生局新优青计划（XYQ2011017）
关键词
黏膜下肿瘤
内镜下全层切除术
金属夹
尼龙绳
Submucosal tumors
Endoscopic full-thick resection
Clip
Endoloop snare
