胃镜下腔内折叠术配合技术的研究

The skills of assistance in the procedure of endoluminal gastroplication

目的探讨和总结胃镜下腔内折叠术的配合技术,评价配合技术在这项新的内镜治疗术中的重要性。方法94例胃食管反流病(GERD)患者,行胃镜下腔内折叠术(ELGP)118例次,根据是否合用射频治疗分为两期,一期32例次(单纯ELGP治疗),二期86例次(ELGP基础上合用射频治疗)。通过对助手配合方法进行回顾,比较两期器械故障发生率、器械安装耗时及单个皱褶缝合耗时(含排除仪器突发故障耗时)的差异,评价熟练及规范配合技术对ELGP术的影响。结果一期平均器械安装时间(30±5)m in,术中出现器械故障9次:缝线脱出2次、缝合头脱落3次、重新调整针壳和导丝的位置2次、缝合坠子脱落2次。二期改进后器械安装顺利,平均器械安装时间缩减到(5±2)m in。仪器安装牢固可靠,术中基本无器械故障发生,二期单个皱褶耗时(30±5.5)m in,明显低于一期(45±10.4)m in(P<0.05)。结论助手熟练规范的配合技术对保证ELGP的顺利进行起着重要作用。

Objective To summarize the methods of assistance in the process of endoluminal gastroplication （EL- GP） , and to evaluate the importance of assistance in this new endoscopic therapy for gastroesophageal reflux disease （GERD）. Methods Total 118 procedures were preformed in 94 cases with definite GERD. We divided this study into two stages according to whether the procedure combined with the usage of radiofrequency energy for GERD. In the first stage, 32 procedures of routine ELGP were performed. In the second stage, the radiofrequency energy and EGLP were involved in 86 procedures. We summarized the skills of assistance including the preoperative psychological training and expiration teaching, the installation of suturing system and preparation of accessory apparatus, intraoperative monitoring, and postoperative following up. The suturing systems troubles, the time consuming of installation and each plicae were recorded, and the difference between two clinical stages was analyzed. Results Compared with the first stage, the mean time of suturing system installation decreased from （30 ±5 ） min to （5 ± 2） min （ P 〈 0.05 ）, and the mean time consuming for one plicae decreased from （45± 10.4） min to （30 ±5.5） min （P 〈 0.05）. The instrumental troubles happened 9 times in first stage, but no troubles happened in second stage. Conclusion The assistance plays an important role in the process of ELGP. As with most therapeutic endoscopies, training and a clear understanding of the equipment are vital for the successful procedure.