消化道病变治疗过程中应用OTSC预防术后穿孔的回顾性分析

Retrospective analysis of the application of over-the-scope clip in the treatment of digestive tract diseases to prevent postoperative perforation

[目的]探讨消化道病变在内镜治疗过程中使用OTSC预防术后穿孔的临床应用。[方法]对内镜治疗中胃肠道占位性病变包括起源于黏膜层隆起型病变及黏膜下层隆起病变治疗中应用OTSC辅助下切除病变或病变切除后应用OTSC封闭创面,预防术后消化道穿孔的患者的临床资料进行回顾性分析。[结果]55例内镜治疗中应用OTSC吻合夹的患者,起源于黏膜层隆起病变27例:11例≤2.0cm病变,包括6例结肠病变(吻合口周围纤维化隆起病变2例,乙状结肠病变2例,结肠肝曲病变2例)和5例十二指肠病变行OTSC辅助下切除治疗;1例<1cm术中创面肌层受损结肠病变予术后OTSC封闭创面;9例术后创面大小2.0~3.0cm者(结直肠病变6例,胃病变1例,十二指肠病变2例)均予电切术后应用OTSC封闭创面;6例术后创面大小>3.0cm者(十二指肠病变3例,结肠病变3例)予电切术后OTSC联合组织夹封闭创面。黏膜下隆起病变28例:7例行OTSC辅助下切除病例(乙状结肠病变1例,十二指肠病变6例);21例胃黏膜下隆起病变中。19例病变电切术后创面大小1.0~3.0cm者应用OTSC组织夹封闭创面,2例病变电切术后创面大小>3.0cm者予术后OTSC吻合夹联合组织夹封闭创面。所有患者均内镜下释放OTSC吻合夹一次性闭合成功,技术成功率100.0%,术后未见迟发穿孔及出血发生,临床成功率100.0%。[结论]OTSC辅助切除病变可用于特殊部位病变或存在黏膜下纤维化病变,以便更完整切除病变,预防术后穿孔,对于≥2 cm术后缺损创面可予OTSC封闭创面预防穿孔,相对于视野清晰,病变暴露较好的胃黏膜下隆起型病变可予电切术后应用OTSC封闭创面,有效预防术后穿孔。总之,消化道病变治疗术中合理应用OTSC,可在一定程度上有效预防术后消化道穿孔,是一种安全、有效的预防穿孔的临床治疗办法。

[Objective]To investigate the clinical application of OTSC in the prevention of postoperative perforation in the treatment of gastrointestinal diseases.[Methods]The clinical data of patients with gastrointestinal space-occupying lesions including mucosal protuberant lesions and submucosal lesions,who were treated with over-the-scope clip(OTSC)assisted resection of lesions,and who were treated with OTSC to seal the wound after resection of lesions to prevent gastrointestinal perforation after operation were retrospectively analyzed.[Results]Among the 55 patients treated with OTSC clamp in endoscopic therapy,27 cases originated from mucosal eminence:11 cases≤2.0cm lesions,including 6 cases of colon lesions(2 cases of perianastomotic fibrosis eminence,2 cases of sigmoid colon lesion,2 cases of hepatocolon lesion)and 5 cases of duodenal lesions underwent OTSC-assisted resection.One case of<1cm intraoperative colonic lesion with facial muscle lesion was closed by OTSC after operation.OTSC was applied to seal the wounds of 9 patients(colorectal lesions in 6 cases,gastric lesions in 1 case,duodenal lesions in 2 cases)with wound size of 2.0-3.0cm.In 6 patients with wound size>3.0cm(3 cases with duodenal lesions and 3 cases with colonic lesions),OTSC combined with tissue clamp closed the wound after electrotomy.There were 28 cases of submucosal eminence lesions:7 cases underwent OTSC-assisted resection(1 case of sigmoid lesions and 6 cases of duodenal lesions).In 21 cases of gastric submucosal eminence.OTSC tissue clamp was applied to seal the wounds of 19 patients with wound size of 1.0-3.0cm after electrosurgical resection,and OTSC anastomosis clamp combined with tissue clamp was applied to seal the wounds of 2 patients with wound size>3.0cm after electrosurgical resection.In all patients,the OTSC anastomosis clamp was released under endoscope and closed successfully at one time,with a technical success rate of 100.0%.No delayed perforation and bleeding were found after surgery,and the clinical success rate was 100.0%.[Conclusion]OTSC-assisted resection of lesions can be used for special site lesions or submucosal fibrotic lesions in order to resect lesions more completely and prevent postoperative perforation,OTSC can be used to prevent perforation for postoperative defect wounds≥2 cm,and OTSC can be used to seal wounds after electroresection for gastric submucosal bulge lesions with clear visual field and better lesion exposure,so as to effectively prevent postoperative perforation.In conclusion,the rational application of OTSC in the treatment of gastrointestinal lesions can effectively prevent postoperative gastrointestinal perforation to a certain extent,and is a safe and effective clinical treatment method for preventing perforation,which is worthy of clinical promotion and reference.