牙线牵引金属夹缝合结直肠内镜黏膜下剥离术后创面的临床应用

Clinical application of suture of mucosal defects after colorectal endoscopic submucosal dissection with metal clips pulled by floss

摘要:

目的 探讨单钳道内镜下通过牙线牵引金属夹辅助缝合结直肠病变内镜黏膜下剥离术（ESD）后创面的优势、疗效及安全性。方法 回顾性分析2018年6月－2020年9月该院通过单钳道内镜下使用牙线牵引辅助金属夹缝合ESD术后创面的患者17例。其中，回盲部2例、升结肠2例、横结肠3例、降结肠3例、乙状结肠3例、直肠4例。观察患者ESD术后创面大小、封闭创面时间、成功率、术后并发症发生情况和肠镜复查结果等。结果 ESD术后创面直径为3.0～6.5 cm，其中16例患者术后创面缝合获得满意效果，成功率为94.1%，1例因牙线过早被剪断使牵引失效导致仅缝合部分创面；创面缝合时间为5～16 min，所有病例均未发生迟发性出血和穿孔，术后3～24个月复查肠镜提示创面金属夹脱落，术后创面修复良好。结论 牙线牵引金属夹缝合结直肠ESD术后创面操作简便，安全实用。

Abstract:

Objective To investigate the advantages, efficacy and safety of suture of the mucosal defects after colorectal endoscopic submucosal dissection under single forceps endoscopy with metal clips pulled by floss.Methods A retrospective analysis was performed on 17 patients who used dental floss traction assisted metal clamping to suture the wounds after ESD operation from June 2018 to September 2020 through single forceps endoscope, among of them, 2 cases of ileocecal region, 2 cases of ascending colon, 3 cases of transverse colon, 3 cases of descending colon, 3 cases of sigmoid colon and 4 cases of rectum. The size of the wound after ESD, the time of wound sealing, the success rate, the incidence of postoperative complications and the results of colonoscopy were observed.Results The diameter of the wounds after ESD was 3.0~6.5 cm, and among them, 16 cases were sutured satisfactorily with a success rate of 94.1%, and in one case, only part of the wound was sutured due to premature cutting of floss and failure of traction. The time of suturing the wound was 5~16 min. No delayed bleeding and perforation occurred in all cases. 3~24 months after operation, reexamination of enteroscopy showed that the metal clips on the wound fell off and the wound recovered well.Conclusion It is simple, safe and practical to suture the wound after colorectal ESD with clips pulled by floss.