荷包缝合法在胃间质瘤内镜下治疗时穿孔的疗效分析

Efficacy of purse-string suture for perforation during endoscopic treatment of gastric stromal tumors

目的探讨金属钛夹联合尼龙绳圈套器操作的荷包缝合法在胃间质瘤患者内镜下治疗时穿孔的临床疗效及安全性。方法 17例行胃间质瘤内镜下治疗时发生穿孔的患者,采用金属钛夹联合尼龙绳圈套器的荷包缝合法对穿孔进行缝合,分析其疗效。结果 17例患者病变均完整切除或挖除,手术时间(116.7±19.1)min,术中出血量为(11.5±7.8)m L,荷包缝合法闭合穿孔耗时(16.2±3.5)min,使用金属钛夹(5.3±1.8)枚,术后住院时间(6.1±2.2)d,术后均未出现迟发性出血、胃壁再穿孔、腹膜炎等并发症,随访4周,患者无特殊并发症,3个月后复查胃镜,创面愈合良好。结论金属钛夹联合尼龙绳圈套器的荷包缝合法能安全有效地闭合内镜下治疗时胃穿孔,耗时短,操作难度低,值得临床推广使用。

ObjectiveTo explore the clinical efficacy and safety of the purse-string suture using titanium clip combined with nylon endoloop for perforation during the endoscopic treatment of gastric stromal tumor. MethodsSeventeen patients suffering from perforation during the endoscopic treatment of gastric stromal tumors were enrolled. Purse-string suture using titanium clip combined with nylon endoloop was performed to close the perforation. The efficacy of this approach was analyzed. ResultsComplete resection or excavation of lesions was performed in all of 17 cases. The operative duration was （116.7±19.1）min and the intraopeartive blood loss was （11.5±7.8）mL. The duration for closing the perforation with pouch-string suture and postoperative hospital stay were （16.2±3.5）min and （6.1±2.2） d respectively. And （5.3±1.8）titanium clips were used during the suture. No complications occurred after operation including delayed bleeding, recurrent gastric perforation and peritonitis. No special complications were found in any cases during the 4-week follow-up. After 3 months, the gastroscope showed that wound healed well. ConclusionThe purse-string suture using titanium clip combined with nylon endoloop can effectively close the gastric perforation during endoscopic treatment safely and effectively, and is less time consuming and less difficult for operation. This approach is worthy of clinical promotion and application.