预防性夹闭创面在内镜下十二指肠乳头切除术中的价值

Prophylactic Application of Trauma Clamping in Endoscopic Papillectomy

目的 探讨应用可旋转组织夹预防性夹闭创面在内镜下十二指肠乳头切除术(endoscopic papillectomy, EP)中的应用价值。方法 回顾性分析2013年7月~2021年12月64例因十二指肠乳头病变行EP的临床资料,前32例乳头切除后创面如有活动性瞬时出血,则实施内镜下止血治疗(对照组),后32例无论切除病变后有无瞬时出血,均在创面下缘6点位起应用可旋转组织夹夹闭创面至胆胰管开口下缘(夹闭组)。比较2组术后并发症。结果 对照组术后延迟出血9例(28.1%),夹闭组未出现术后延迟出血,2组差异具有统计学意义(P=0.002)。夹闭组术后胰腺炎发生率也显著下降[8例(25.0%)vs. 18例(56.3%),χ^(2)=6.478,P=0.011]。2组胆管炎、穿孔发生率差异均无统计学意义(P>0.05)。结论 EP术中应用可旋转组织夹预防性夹闭创面有助于减少术后延迟出血。

Objective To investigate the value of prophylactic application of rotatable trauma clamping in endoscopic papillectomy(EP).Methods Clinical data of 64 patients with duodenal papillopathy who underwent EP from July 2013 to December 2021 were retrospectively analyzed.In the first 32 cases,endoscopic hemostasis was performed if there was active transient bleeding on the trabecular surface after papillary resection(control group),and in the last 32 cases,regardless of transient bleeding after resection of the lesion,a rotatable tissue clamp was applied to the trabecular surface from 6 o’clock direction on the lower edge of the trabecular surface(clamping group).Postoperative complications were compared between the two groups.Results There were 9 cases(28.1%)of delayed postoperative bleeding in the control group and no delayed postoperative bleeding in the clamping group,with a statistically significant difference between the two groups(P=0.002).The incidence of postoperative pancreatitis was also significantly lower in the clamping group[8 cases(25.0%)vs.18 cases(56.3%),χ^(2)=6.478,P=0.011].There was no statistical difference in the incidence of cholangitis or perforation between the two groups(P>0.05).Conclusion Prophylactic application of rotatable trauma clamping during EP helps reduce the incidence of delayed postoperative bleeding.