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

Jing TANG; Dan YANG; Wenyong SHEN; Danping LU; Yan XUE; Sha WEI; Tao WU; Aimin LIU

doi:10.16016/j.1000-5404.201910184

您当前的位置：

首页 >

文章列表页 >

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

Clinical Medicine | 更新时间：2026-01-09

- Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract
- Journal of Third Military Medical University Vol. 42, Issue 7, Pages: 744-747(2020)
- 作者机构：
  
  408099 重庆, 重庆市涪陵中心医院消化科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201910184
  CLC： R573;R615;R619.5
- Received：27 October 2019，
  
  Revised：2020-01-06，
  
  Published：15 April 2020
- 稿件说明：
移动端阅览
Jing TANG, Dan YANG, Wenyong SHEN, et al. Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract[J]. Journal of Third Military Medical University, 2020, 42(7): 744-747.
DOI：

Jing TANG, Dan YANG, Wenyong SHEN, et al. Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract[J]. Journal of Third Military Medical University, 2020, 42(7): 744-747. DOI： 10.16016/j.1000-5404.201910184.

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。

Abstract

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

Keywords

references

ISOMOTO H, NISHIYAMA H, YAMAGUCHI N, et al . Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms[J ] . Endoscopy, 2009, 41(8): 679-683. DOI:10.1055/s-0029-1214979.

TERASAKI M, TANAKA S, SHIGITA K, et al . Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms[J ] . Int J Colorectal Dis, 2014, 29(7): 877-882. DOI:10.1007/s00384-014-1901-3.

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. DOI:10.3969/j.issn.1006-5709.2017.11.019.

ZHANG Z H, LIU X G, LI L P. The value of endoscopic ultrasonography in diagnosis of upper gastrointestinal sub-mucosal lesions[J]. Chin J Gastroenterol Hepatol, 2017, 26(11): 1273-1277. DOI:10.3969/j.issn.1006-5709.2017.11.019.

赵春玉, 黄留业.胃固有肌层间质瘤消化内镜下微创治疗与腹腔镜治疗的比较分析[J].中国临床实用医学, 2015(4): 13-15. DOI:10.3760/cma.j.issn.1673-8799.2015.04.005.

ZHAO C Y, HUANG L Y. Comprasion and analysis between endoscopy and laparoscopy in resection of gastic stomal tumors originated from the muscularis propria[J]. China Clin Pract Med, 2015(4): 13-15. DOI:10.3760/cma.j.issn.1673-8799.2015.04.005.

XU Q Y, CHEN J J, LAI Y D, et al . Therapeutic value of endoscopic resection of tumors originated from gastric fundus muscularis propria[J ] . Chin J Digestive Endoscopy, 2015, 32(3): 175-179.

CATALANO F, RODELLA L, LOMBARDO F, et al . Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study[J ] . Gastric Cancer, 2013, 16(4): 563-570. DOI:10.1007/s10120-012-0225-7.

VON RENTELN D, SCHMIDT A, VASSILIOU M C, et al . Endoscopic full-thickness resection and defect closure in the colon[J ] . Gastrointest Endosc, 2010, 71(7): 1267-1273. DOI: 10.1016/j.gie.2009.12.056.

VOERMANS R P, VERGOUWE F, BREEDVELD P, et al . Comparison of endoscopic closure modalities for standardized colonic perforations in a porcine colon model[J ] . Endo scopy, 2011, 43(3): 217-222. DOI: 10.1055/s-0030-1256072.

KOPELMAN Y, SIERSEMA P D, BAPAYE A, et al . Endoscopic full-thickness GI wall resection: current status[J ] . Gastrointest Endosc, 2012, 75(1): 165-173. DOI: 10.1016/j.gie.2011.08.050.

ZHANG Y, WANG X, XIONG G Y, et al . Complete defect closure of gastric submucosal tumors with purse-string sutures[J ] . Surg Endosc, 2014, 28(6): 1844-1851. DOI: 10.1007/s00464-013-3404-7.

李全朋, 缪林, 张秀华, 等.荷包缝合技术治疗内镜相关消化道穿孔[J].中华消化内镜杂志, 2016, 33(8): 558-560. DOI: 10.3760/cma.j.issn.1007-5232.2016.08.017.

LI Q P, MIAO L, ZHANG X H, et al . Treatment of endoscopically related gastrointestinal perforation with purse suture[J ] . Chin J Dig Endosc, 2016, 33(8): 558-560. DOI: 10.3760/cma.j.issn.1007-5232.2016.08.017.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰