和谐夹联合乐奥尼龙绳闭合胃壁全层切除术后缺损的初步应用

Application of LeClampTM Endoloops and Hemoclips to Close the Defects Resulted from Endoscopic Full-Thickness Resection with Single-Channel Gastroscope

目的探讨和谐夹联合乐奥尼龙绳在单通道内镜下闭合胃间质瘤全层切除术后胃壁缺损的可行性及安全性。方法回顾性分析2015年4月-2016年2月17例胃底间质瘤行内镜下全层切除术治疗的患者，胃壁缺损予和谐夹联合乐奥尼龙绳在单通道内镜下完全闭合，所有患者均予随访。评估指标包括患者临床一般资料、病变大小、整块切除率、操作时间、闭合成功率及术后并发症。结果17例患者均成功完成内镜下全层切除术，整块切除率为100％，缺损闭合成功率为100％，闭合操作平均耗时10min，病变最长径平均值为2．6cm，术后发生贲门黏膜撕裂及迟发出血各1例，均内科保守治疗成功，术后1个月创面均愈合。结论在单通道内镜下，和谐夹联合乐奥尼龙绳闭合内镜全层切除术后胃壁缺损，是一种相对简单且安全、有效的方法。

Objective To evaluate the application and safety of a new method of closing large gastric defects left after endoscopic full-thickness resection （EFTR）, using LeClampTM endoloops and Hemoclips by means of single-channel endoscope. Methods We retrospectively analyzed 17 patients who were treated in our hospital between April 2015 and February 2016 with gastric fundus gastrointestinal stromal tumors and who consequently underwent EFTR. The large gastric post-EFTR defects were completely closed with LeClampTM endoloops and Hemoclips using single-channel endoscope, and all the patients were discharged with subsequent endoscopic and clinical follow-up. Patient characteristics, tumor size, en bloc resection rate, closure operation time, and postoperative adverse events were evaluated. Results EFTR was successfully performed on 17 patients, and the en bloc resection rate was 100%. Complete closure of all the gastric post-EFTR defects was achieved （success rate 100%）. The mean closure operation time was 10 min （range 8 ～ 13 min）. The mean maximum size of the lesions was 2.6 cm （range 2.0 ～ 3.5 cm）. One Mallory-Weiss syndrome and one delayed bleeding were resolved with nonsurgical treatment. The wounds were healed in all cases 1 month after the procedure. Conclusion The use of metallic clips and novel endoloops with single-channel endoscope is a relatively safe, easy, and feasible method for repairing large gastric post-EFTR defects.