单钳道钛夹联合尼龙圈“荷包”缝合胃黏膜下肿瘤全层切除创面缺损的效果
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摘要
目的:研究胃黏膜下肿瘤全层切除术(EFTR)术后创面缺损采用内镜下单钳道钛夹联合尼龙圈"荷包"缝合的临床效果。方法:回顾性分析2016年2月-2017年7月在笔者所在医院接受胃黏膜下肿瘤全层切除术治疗的82例患者临床资料,按照手术后止血方法分为观察组和对照组,每组41例。对照组术后对创面予以常规止血处理,确定无活动性出血后结束手术。观察组术后则对创面予以单钳道内镜下钛夹联合尼龙圈"荷包"缝合。比较两组手术时间、缝合时间、术后住院时间、术后并发症发生情况,以及术后12个月复发率、远处转移率。结果:观察组与对照组的手术时间、缝合时间对比差异均无统计学意义(P>0.05);但观察组术后住院(5.62±1.19)d,短于对照组的(6.63±2.15)d。观察组迟发性出血、迟发性穿孔、术后感染及术后腹痛发生率分别与对照组相比,差异均无统计学意义(P>0.05)。观察组术后12个月复发率及远处转移率与对照组相比差异均无统计学意义(P>0.05)。结论:胃黏膜下肿瘤全层切除术后创面缺损采用单钳道内镜下钛夹联合尼龙圈"荷包"缝合效果较好,不会增加并发症发生率,且不会增加术后复发率及远处转移率。
Objective:To research the clinical effect of endoscopic single-channel titanium clip combined with nylon ring "Pouch" suture for wound defect after endo-scopic full-thickness resection(EFTR) of gastric submucosal tumors.Method:The clinical data of 82 patients receiving endo-scopic full-thickness resection of gastric submucosal tumors in our hospital from February 2016 to July 2017 were analyzed retrospectively.They were divided into the observation group and the control group by methods of hemostasis after operation,41 cases in each group.Patients in the control group were given routine treatment of wound hemostasis,no active bleeding after the end of surgery.In the observation group,single-channel titanium clip combined with nylon ring "Pouch" suture for wound defect after endo-scopic full-thickness resection was given to the wound after.The two groups were compared with operative time,suture time,postoperative hospital stay,recurrence rate of 12 months and the incidence of postoperative complications,distant metastasis rate.Result:The operation time and suture time of the observation group and the control group were not significantly different(P>0.05),but the postoperative hospitalization time of the observation group was(5.62±1.19)d,significantly lower than(6.63±2.15)d of the control group.The incidence of delayed bleeding,delayed perforation,postoperative infection and postoperative abdominal pain in the observation group compared with the control group,the differences were not statistically significant(P>0.05).The recurrence rate and distant metastasis rate of the observation group at 12 months after operation compared with the control group,the differences were not statistically significant(P>0.05).Conclusion:Titanium clip combined with nylon ring "Pouch" suture under single forceps endoscopy after total gastric submucosal tumor resection is effective,it will not increase the incidence of complications and the recurrence rate and distant metastasis rate after operation.
Objective:To research the clinical effect of endoscopic single-channel titanium clip combined with nylon ring "Pouch" suture for wound defect after endo-scopic full-thickness resection(EFTR) of gastric submucosal tumors.Method:The clinical data of 82 patients receiving endo-scopic full-thickness resection of gastric submucosal tumors in our hospital from February 2016 to July 2017 were analyzed retrospectively.They were divided into the observation group and the control group by methods of hemostasis after operation,41 cases in each group.Patients in the control group were given routine treatment of wound hemostasis,no active bleeding after the end of surgery.In the observation group,single-channel titanium clip combined with nylon ring "Pouch" suture for wound defect after endo-scopic full-thickness resection was given to the wound after.The two groups were compared with operative time,suture time,postoperative hospital stay,recurrence rate of 12 months and the incidence of postoperative complications,distant metastasis rate.Result:The operation time and suture time of the observation group and the control group were not significantly different(P>0.05),but the postoperative hospitalization time of the observation group was(5.62±1.19)d,significantly lower than(6.63±2.15)d of the control group.The incidence of delayed bleeding,delayed perforation,postoperative infection and postoperative abdominal pain in the observation group compared with the control group,the differences were not statistically significant(P>0.05).The recurrence rate and distant metastasis rate of the observation group at 12 months after operation compared with the control group,the differences were not statistically significant(P>0.05).Conclusion:Titanium clip combined with nylon ring "Pouch" suture under single forceps endoscopy after total gastric submucosal tumor resection is effective,it will not increase the incidence of complications and the recurrence rate and distant metastasis rate after operation.
引文
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[10]陈茂顺,黄淑华,陈辉杰,等.改制双钳道内镜在ESD术后穿孔中的应用价值[J].微创医学,2016,11(6):857-859.
[11]唐静,卢丹萍,况晶,等.单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析[J].第三军医大学学报,2017,39(14):1493-1497.
[12]黄亮,张烁,金波,等.单腔镜荷包缝合技术在黏膜下剥离术穿孔后创面闭合中的应用[J].浙江医学,2016,38(12):989-991.
[2]张志宏,刘晓岗,李良平.超声内镜是否足以精准诊断上消化道黏膜下肿物[J].胃肠病学和肝病学杂志,2017,26(11):1273-1277.
[3]黄军,郑海伦,王启之,等.微探头超声内镜辅助内镜治疗消化道黏膜下肿物291例临床分析[J].中华全科医学,2017,15(12):2038-2041.
[4]邹伟清,吴建维,薛立峰,等.食管乳头状瘤应用内镜活检钳除术的临床分析[J].中国医学创新,2018,15(19):105-107.
[5]唐凤英,张伟,杨银利,等.内镜下橡皮圈套扎器法黏膜切除术治疗上消化道黏膜下小肿瘤的效果分析[J].临床医学研究与实践,2017,2(33):83-84.
[6]方兆山,黄海,王平,等.经皮肝穿刺硬质胆道镜治疗复发性肝胆管结石的疗效[J].实用医学杂志,2016,32(18):3034-3037.
[7]姜琳,孙晓滨,任春蓉,等.内镜下黏膜剥离术治疗消化道黏膜下肿瘤的护理配合[J].现代临床医学,2017,43(4):300-302.
[8]王利,文黎明.食管癌内镜下诊治进展[J].现代医院,2016,16(5):638-640.
[9]胡晓,李良平,肖迅,等.内镜下黏膜剥离术治疗上消化道早期癌及癌前病变的临床疗效[J].现代消化及介入诊疗,2017,22(1):9-12.
[10]陈茂顺,黄淑华,陈辉杰,等.改制双钳道内镜在ESD术后穿孔中的应用价值[J].微创医学,2016,11(6):857-859.
[11]唐静,卢丹萍,况晶,等.单钳道内镜跨越式荷包缝合法封闭医源性消化道黏膜缺损42例分析[J].第三军医大学学报,2017,39(14):1493-1497.
[12]黄亮,张烁,金波,等.单腔镜荷包缝合技术在黏膜下剥离术穿孔后创面闭合中的应用[J].浙江医学,2016,38(12):989-991.