消化道肿物内镜下切除后两种缝合方法封闭创面的对比研究

Comparison of two kinds of suturing methods for endoscopic resection in gastrointestinal tumor

摘要:

探讨消化道肿物经内镜切除后创面采用尼龙绳联合金属夹荷包缝合技术及单用金属夹缝合的临床应用，了解两种缝合方法在术后预防发热、腹痛、出血和穿孔的临床疗效，旨在探索内镜下切除消化道肿物后创面的简单、有效、经济的闭合方法。方法?回顾性分析首都医科大学附属北京友谊医院2016年1月-2017年6月经内镜黏膜下剥离术（ESD）切除肿瘤性病变的84例患者，单用金属夹（金属夹组）缝合创面42例，金属夹联合尼龙绳荷包缝合（荷包缝合组）创面42例，比较两组金属夹数目、耗用时间、操作成功率、术后并发发热、腹痛、出血、穿孔及金属夹滞留情况。结果?荷包缝合组创面大于金属夹缝合组，而使用金属夹数目、操作时间两组无明显差异，金属夹缝合操作成功率88.10%（37/42），荷包缝合组为100.00%，术后一过性发热（发热时间≤24?h）金属夹组3例，荷包缝合组2例，两组间比较差异无统计学意义（P?>0.05），感染性发热（>24?h）金属夹组7例，荷包缝合组1例，两组间比较差异有统计学意义（P?<0.05），金属夹组术后腹痛7例，迟发性出血5例，迟发性穿孔4例，荷包缝合组腹痛1例，无迟发性出血、穿孔发生，两组间比较差异有统计学意义（P?<0.05），金属夹组中1例并发迟发性出血、穿孔经内镜下荷包缝合、禁食水、卧床休息、抗感染和止血等治疗痊愈，3例迟发性穿孔转外科手术治疗，4例迟发性出血经内镜下止血成功。住院时间荷包缝合组明显低于金属夹组，两组间比较差异有统计学意义（P?<0.05），金属夹组中有6例金属夹未完全脱落，荷包缝合组全部脱落。结论?尼龙绳联合金属夹荷包缝合技术能有效闭合内镜下消化道肿瘤切除后创面，操作技术简单，住院时间短，能减少或者防止腹痛、迟发性穿孔、出血的发生，无金属夹滞留。

Abstract:

To investigate the clinical application of nylon girdle combined with metal clip, and metal clip suture wound surface for endoscopic resection in gastrointestinal tumor, study the clinical effects that its prevention of fever, abdominal pain, bleeding and perforation in the two kinds of suture methods and explore the simple, effective and economical wound closing method of the endoscopic resection in gastrointestinal tumor.?Methods?84 cases with gastrointestinal tumor and received endoscopic resection from January 2016 to June 2017 were analyzed retrospectively. 42 cases sutured wound surface with only metal clip (metal clip group), 42 cases suture wound surface with metal clip and nylon rope bag suture (purse sutured group). The number of metal clips, the time of operation, the success rate of operation, the postoperative fever, abdominal pain, bleeding, perforation and metal retention were compared between the two groups.?Results?The size of wound surface of purse suture group was more than the metal clip suture group. But they did not have significant difference between the two groups, which used the number of metal clip, and the operation time. The success rate of metal clip group was 88.10% (37/42). The success rate of purse sutured group was 100% . In postoperative transient fever (fever time?≤?24 h), it had 3 case in metal clip group and 2 case in purse sutured group. There was no significant difference between the two groups (P?>?0.05). In infective fever (>?24?h), it had 7 case in metal clip group and one case in purse sutured group. There was significant difference between the two groups (P?