改制双钳道内镜在ESD术后穿孔中的应用价值

The application value of improved double clamp endoscopy in the perforation after ESD surgery

目的探讨改制双钳道内镜在ESD术后并发穿孔中应用的可行性和有效性。方法选取固有肌层胃黏膜下肿瘤患者12例,对其中行ESD术后并发穿孔直径〉2 cm穿孔的患者行内镜下手术干预治疗,利用改制双钳道内镜配合尼龙圈和钛夹对穿孔行荷包式缝合。观察缝合成功率,评估该方法的可操作性。结果单钳道内镜通过添加简易管道改制成双钳道内镜,配合尼龙圈和钛夹缝合技术成功修补直径2-3 cm的ESD术后穿孔。术后完整随访11例,随访时间为3-6个月,经内镜复查切口均愈合良好。结论改制后双钳道内镜下进行荷包式缝合、修补ESD术后大穿孔并发症操作简单,是一种经济、简便、快速、安全有效的辅助方式。在拥有普通单钳道内镜的医院即可开展此项技术,缩短手术时间,尽快安全、有效地修复穿孔,避免行二次外科手术,减少术后感染发生率,具有较大的临床实用价值,有助于更广泛深入地开展消化道病变的EMR和ESD技术。

Objective To explore the feasibility and effectiveness of application of improved double clamp endoscopy in the perforation after ESD surgery. Methods A total of 12 cases with gastric submucosal tumor located in intrinsic muscle layer were selected,and the patients who were complicated with the perforation diameter over 2 cm after ESD operation were treated by endoscopic surgery,and improved double clamp endoscopy were used with nylon ring and titanium clip on the perforated line of the purse string suture.The suture success rates are receded so as to evaluate the feasibility of this method. Results Double clamp endoscopy,made by adding a simple pipe into single forceps endoscopy, can repair the postoperative perforation of 2 to 3 cm in diameter after ESD with nylon ring and titanium clips. 11 cases were followed up postoperatively for 3 to 6 months,with all endoscopic incisions healed. Conclusion The improved double clamp endoscopy is easy to operate pouch suturing postoperative complications after ESD,and can be carried out in hospitals with ordinary single forceps endoscopy,proved to be economical,convenient,safe and effective. It can shorten the operation time and repair perforations fast and effectively to avoid a second time surgery and reduce postoperative infection. It has great clinical practical value,and contributes to a more extensive and deeper research in the digestive tract lesions of EMR and ESD technology.