内镜下尼龙绳联合止血夹荷包缝合术在修复ESD后胃壁缺损的临床应用(1)
【摘要】目的探討双通道内镜下荷包缝合术、单通道内镜下荷包缝合术及单通道内镜下钩式尼龙绳荷包缝合术在修复内镜黏膜下剥离术(ESD)后胃壁缺损的临床应用，评价其疗效及安全性。方法选择需行ESD切除胃壁黏膜下隆起性病变的45例患者，ESD后在内镜下根据胃壁缺损的部位、有无穿孔选择双通道内镜下荷包缝合术、单通道内镜下荷包缝合术及单通道内镜下钩式尼龙绳荷包缝合术缝合创面。记录手术情况及病理活组织检查(活检)结果，术后1个月行电子胃镜，观察创面的愈合情况。结果45例患者在行ESD时，2例止血后转外科择期手术治疗，其余43例均通过ESD剥离胃壁黏膜下隆起性病变，其中11例发生全层穿孔。应用双通道内镜下荷包缝合术完成胃壁缺损修复17例，单通道内镜下荷包缝合术14例，单通道内镜下钩式尼龙绳荷包缝合术12例。术后43例患者的创面干净，充血、水肿程度轻。术后1个月后复查，43例患者的创面均愈合良好，其中31例患者可观察到止血夹及尼龙绳从粪便排出，另12例患者给予腹部X线检查，均未发现止血夹或尼龙绳残留。所有患者均获得完整的标本送活检，其中多数为间质瘤(33例)，其次为胃体异位胰腺(4例)和平滑肌瘤(3例)。结论ESD可完整切除胃壁黏膜下肿物并获取最终活检结果，ESD后内镜尼龙绳联合止血夹荷包缝合修复创面安全、有效，应根据胃壁缺损灶位置、有无穿孔等情况选择最佳的缝合方法。
【关键词】荷包缝合；内镜黏膜下剥离术；胃壁；修复
ClinicalapplicationofendoscopicpursestringsuturewithnylonstringcombinedwithhemostaticclipinrepairinggastricwalldefectsafterESDWangFuqun，WangShengbing，LiuBoyingDigestiveEndoscopicCenter，MeizhouHospitalAffiliatedtoZhongshanUniversity(HuangtangHospital)，Meizhou514021，China
Correspondingauthor，WangShengbing，Email：13802360620@139com
【Abstract】ObjectiveToinvestigatetheclinicalapplicationofendoscopicdualportpursestringsuture，singleportpursestringsutureandsingleportloopnylonpursestringsutureintherepairofgastricwalldefectsafterendoscopicsubmucosaldissection(ESD)TheclinicalefficacyandsafetywereevaluatedamongthreetechniquesMethodsFortyfivepatientswhowerescheduledtoundergoESDfortheresectionofsubepithelialmucosallesionswereselectedAfterESD，threetechniqueswereperformedaccordingtothesiteofthegastricwalldefectsandtheincidenceofgastricperforationThesurgicaloutcomesandpathologicalexaminationresults(biopsy)wererecordedElectronicgastroscopewasperformedonemonthaftertheoperationtoobservethewoundhealingResultsWhenESDwasperformedin45patients，2patientswereswitchedtosurgeryafterhemostasismanagementFortheremaining43cases，allsubepitheliallesionswereresectedbyESD，and11caseshadfullthicknessperforationEndoscopicdualportpursestringsuturewasperformedtorepairthegastricwalldefectsin17patients，singleportpursestringsuturein14andsingleportloopnylonpursestringsuturein12Aftersurgery，thewoundssurfacewascleanwithslightcongestionandedemain43patientsDuringreexaminationatpostoperative1month，thewoundsof43patientswereallhealedwell，and31patientscouldobservethehemostaticclipsandnylonstringsexcretedfromthefecesAnother12patientsreceivedabdominalXrayexamination，andnohemostaticclipsornylonstringswerefoundAllpatientsobtainedcompletespecimensforpathologicalbiopsy，andmostofthemwerediagnosedwithstromaltumors(n=33)，followedbyectopicpancreas(n=4)andleiomyoma(n=3)ConclusionsESDcancompletelyremovethesubmucosalgastrictumorsandobtainthepathologicalbiopsyresultsAfterESD，pursestringsuturewithendoscopicnylonstringcombinedwithhemostaticclipcaneffectivelyandsafelyrepairthewoundsTheoptimalsuturingapproachshouldbedeterminedaccordingtothesiteofgastricwalldefectsandwhetherornotthepresenceofperforation, http://www.100md.com(汪福群 王胜炳 刘波颖)
【关键词】荷包缝合；内镜黏膜下剥离术；胃壁；修复
ClinicalapplicationofendoscopicpursestringsuturewithnylonstringcombinedwithhemostaticclipinrepairinggastricwalldefectsafterESDWangFuqun，WangShengbing，LiuBoyingDigestiveEndoscopicCenter，MeizhouHospitalAffiliatedtoZhongshanUniversity(HuangtangHospital)，Meizhou514021，China
Correspondingauthor，WangShengbing，Email：13802360620@139com
【Abstract】ObjectiveToinvestigatetheclinicalapplicationofendoscopicdualportpursestringsuture，singleportpursestringsutureandsingleportloopnylonpursestringsutureintherepairofgastricwalldefectsafterendoscopicsubmucosaldissection(ESD)TheclinicalefficacyandsafetywereevaluatedamongthreetechniquesMethodsFortyfivepatientswhowerescheduledtoundergoESDfortheresectionofsubepithelialmucosallesionswereselectedAfterESD，threetechniqueswereperformedaccordingtothesiteofthegastricwalldefectsandtheincidenceofgastricperforationThesurgicaloutcomesandpathologicalexaminationresults(biopsy)wererecordedElectronicgastroscopewasperformedonemonthaftertheoperationtoobservethewoundhealingResultsWhenESDwasperformedin45patients，2patientswereswitchedtosurgeryafterhemostasismanagementFortheremaining43cases，allsubepitheliallesionswereresectedbyESD，and11caseshadfullthicknessperforationEndoscopicdualportpursestringsuturewasperformedtorepairthegastricwalldefectsin17patients，singleportpursestringsuturein14andsingleportloopnylonpursestringsuturein12Aftersurgery，thewoundssurfacewascleanwithslightcongestionandedemain43patientsDuringreexaminationatpostoperative1month，thewoundsof43patientswereallhealedwell，and31patientscouldobservethehemostaticclipsandnylonstringsexcretedfromthefecesAnother12patientsreceivedabdominalXrayexamination，andnohemostaticclipsornylonstringswerefoundAllpatientsobtainedcompletespecimensforpathologicalbiopsy，andmostofthemwerediagnosedwithstromaltumors(n=33)，followedbyectopicpancreas(n=4)andleiomyoma(n=3)ConclusionsESDcancompletelyremovethesubmucosalgastrictumorsandobtainthepathologicalbiopsyresultsAfterESD，pursestringsuturewithendoscopicnylonstringcombinedwithhemostaticclipcaneffectivelyandsafelyrepairthewoundsTheoptimalsuturingapproachshouldbedeterminedaccordingtothesiteofgastricwalldefectsandwhetherornotthepresenceofperforation, http://www.100md.com(汪福群 王胜炳 刘波颖)