单钳道内镜下荷包缝合术在结直肠内镜黏膜下剥离术后的临床应用

Clinical application of single forcep purse-string suture the wound of colorectal lesions after endoscopic submucosal dissection

摘要:

目的 探讨采用单钳道内镜下荷包缝合术夹闭结直肠内镜黏膜下剥离术（ESD）后创面的疗效及安全性。方法 回顾性分析2019年10月－2020年10月在东莞东华医院消化内科住院并诊断为结直肠病变行ESD术的220例患者的临床资料，共224处病变。根据ESD术后创面是否行荷包缝合术分为研究组（ESD术后行荷包缝合术夹闭创面，n = 121）和对照组（ESD术后创面不夹闭，n = 103），总结两组患者治疗完成情况、并发症发生情况及随访结果。结果 病灶位于直肠114处（50.89%），左半结肠56处（25.00%），右半结肠36处（16.07%），回盲部18处（8.04%）。研究组手术时间（73.12±12.23）min较对照组的（69.24±11.54）min长，但差异无统计学意义（P > 0.05）；研究组术后平均住院时间（3.85±0.98）d，较对照组的（5.04±1.24）d短，差异有统计学意义（P < 0.05）；研究组术后总体并发症发生率、术后出血发生率明显低于对照组，两组比较，差异均有统计学意义（P < 0.05）；研究组住院费用为（23 728.85±3 916.89）元，较对照组的（22 820.84±5 051.80）元多，但两组比较，差异无统计学意义（P > 0.05）；两组术后穿孔、发热和腹痛腹胀发生率比较，差异均无统计学意义（P > 0.05）。结论 单钳道内镜下荷包缝合术能有效夹闭结直肠ESD术后创面，缩短术后住院时间，减少术后出血，降低总体并发症发生率，安全性高，不增加总体住院费用，值得临床推广应用。

Abstract:

Objective To explore the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of colorectal after ESD for patients with colorectal lesions.Methods A retrospective study was conducted on the clinical data of 220 patients with 224 colorectal disease and ESD surgery from October 2019 to October 2020. According to whether purse-string suture was performed after ESD, all the patients were divided into study group (the wound was clipped by purse-string suture, n = 121) and the control group (the wound was not closed, n = 103), the completion of treatment, complications and follow-up results were summarized.Results The lesions were located in the rectum (114, 50.89%), left colon (56, 25.00%), right colon (36, 16.07%), and the ileocecal injunction (18, 8.04%). The operation time of the study group was (73.12 ± 12.23) min, there was longer than that in control group [(69.24 ± 11.54) min], but the difference was not statistically significant (P > 0.05); The average hospital stay in the study group was (3.85 ± 0.98) d, it was shorter than that in control group [(5.04 ± 1.24) d]; The overall incidence of postoperative complications and postoperative bleeding in the study group were lower than that in control group, the differences were statistically significant (P < 0.05). The hospitalization expenses was (23 728.85 ± 3 916.89) yuan in the study group, there were more than that in control group (22 820.84 ± 5 051.80) yuan, but the difference was not statistically significant (P > 0.05); There was no significant difference in the incidence of postoperative perforation, fever, abdominal pain, and abdominal distension between the two groups (P > 0.05).Conclusion Single forcep endoscopic purse-string suture can effectively close the wound of colorectal lesions after ESD, shorten the postoperative hospital stay, reduce postoperative bleeding and the overall risk of postoperative complications. This method is safe, does not increase the overall hospitalization costs, and is suitable for clinical application and promotion.