单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔

唐静; 杨丹; 沈文拥; 卢丹萍; 薛焱; 魏沙; 吴涛; 刘爱民

doi:10.16016/j.1000-5404.201910184

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单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔

临床医学 | 更新时间：2026-01-09

- 单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔
- Efficacy of single-clamp endoscopic 8-shaped suture for closure of iatrogenic perforation in the upper digestive tract
- 第三军医大学学报 2020年42卷第7期页码：744-747
- 作者机构：
  
  408099 重庆, 重庆市涪陵中心医院消化科
- 作者简介：
  
  [ 刘爱民. E-mail:512667798@qq.com LIU Aimin, E-mail:512667798@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201910184
  中图分类号： R573;R615;R619.5
- 收稿：2019-10-27，
  
  修回：2020-01-06，
  
  纸质出版：2020-04-15
- 稿件说明：
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唐静, 杨丹, 沈文拥, 等. 单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔[J]. 第三军医大学学报, 2020,42(7):744-747.

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.
唐静, 杨丹, 沈文拥, 等. 单钳道内镜“8”字辅助缝合法封闭上消化道主动医源性穿孔[J]. 第三军医大学学报, 2020,42(7):744-747. DOI： 10.16016/j.1000-5404.201910184.

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

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