两种缝合方式在贲门下及胃底黏膜下肿瘤全层切除术中的比较

Comparison Between Two Suturing Methods After Endoscopic Full-Thickness Resection of Submucosal Tumors in Subcardia and Gastric Fundus

目的探讨贲门下及胃底≥1 cm的黏膜下肿瘤(submucosal tumors,SMT)经内镜下全层切除(endoscopic full-thickness resection,EFTR)后创面行两种缝合方式的效能和安全性。方法回顾性分析2021年3月—2023年3月于复旦大学附属中山医院厦门医院住院行EFTR的贲门下及胃底SMT(≥1 cm)的患者,共纳入33例患者,其中16例患者的创面采用尼龙绳联合金属夹行荷包缝合法(尼龙绳组),17例患者采用单纯金属夹缝合法闭合创面(金属夹组)。比较术后创面两种缝合方式的手术时间、创面缝合时间、金属夹使用数量、术后并发症、术后留置胃管时间、抗生素应用时间、住院时间。结果两组缝合方式均有效闭合创面。尼龙绳组的手术时间及缝合时间比金属夹组长,差异有统计学意义(P<0.05)。在金属夹使用数量、术后并发症、术后留置胃管时间、抗生素使用时间、住院时间方面,两组差异无统计学意义(P>0.05)。结论两种缝合方式均能有效缝合胃SMT行EFTR术后的创面,但对于贲门下及胃底这类特殊部位的创面,单纯金属夹缝合更加省时。

Objective To investigate the efficacy and safety of two suture methods closing the wound of subcardia and gastric fundus after endoscopic full-thickness resection(EFTR)for patients with submucosal tumors(SMT)greater than or equal to 1cm.Methods Patients with subcardia and fundus SMT(≥1 cm)who were admitted to Zhongshan Hospital(Xiamen),Fudan University from March 2021 to March 2023 for EFTR were retrospectively analyzed.A total of 33 patients were included,16 patients underwent purse-string suture with endoloop and metal clip(the nylon rope group),17 patients underwent wound suture with metal clip only(the metal clip group).The operation time,wound suturing time,quantity of metal clip applied,postoperative complications,gastric tube indwelling time,application of antibiotics and hospital stay were compared between two suture methods.Results All the patients successfully received wound suture.The operation time and suturing time of the nylon rope group was longer than that of the metal clip group,the difference was statistically significant(P<0.05).There were no significant differences in comparison of quantity of metal clip applied,postoperative complications,gastric tube indwelling time,application of antibiotics and hospital stay between the two groups(P>0.05).Conclusion Both suture methods can effectively close the postoperative wound of EFTR with SMT,but suture with metal clip only is more time-efficient for postoperative wound in subcardia and gastric fundus.