双尼龙绳荷包缝合法闭合内镜全层切除术治疗胃黏膜下肿瘤术后创面的疗效分析

Analysis of the therapeutic effect of double nylon rope purse string suture closing the postoperative wounds of the treatment of endoscopic full thickness resection for gastric submucosal tumors

摘要:

目的 探讨双尼龙荷包缝合法闭合内镜全层切除术（EFR）治疗胃黏膜下肿瘤（SMT）术后创面的临床应用价值及其安全性。方法 回顾性分析2020年6月－2023年3月该院收治的104例胃固有肌层SMT患者的临床资料，根据缝合方法不同，分为：单尼龙绳荷包缝合组（48例）和双尼龙绳荷包缝合组（56例）。比较两组患者手术情况、术后情况和长期随访情况。结果 所有病灶均在内镜下完全切除。双尼龙绳荷包缝合组病灶直径明显大于单尼龙绳荷包缝合组（P = 0.040）。单尼龙绳荷包缝合组中1例术后穿孔，4例发热，6例腹痛；双尼龙绳荷包缝合组无术后穿孔，5例发热，6例腹痛，两组患者比较，差异无统计学意义（P > 0.05）。两组患者术后无转外科病例，均顺利出院。术后3个月复查，单尼龙绳荷包缝合组7例可见钛夹和/或尼龙绳残留，明显少于双尼龙绳荷包缝合组的18例残留钛夹和/或尼龙绳，差异有统计学意义（P = 0.037）。结论 与单尼龙绳荷包缝合相比，对于直径较大的病灶（≥3 cm），双尼龙绳荷包缝合能有效地缝合EFR治疗胃SMT术后创面。

Abstract:

Objective To evaluate the clinical value and safety of double nylon rope purse string suture closing the postoperative wounds of the treatment of endoscopic full thickness resection (EFR) for gastric submucosal tumors (SMT).Methods We retrospectively analyzed the clinical data of 104 patients with gastric SMT originating from the muscularis propria, from June 2020 to March 2023. According to different suture methods, they were divided into single nylon rope purse string suture group (48 cases) and double nylon rope purse string suture group (56 cases). The patients' operative, postoperative, and long-term follow-up conditions were evaluated.Results All tumors were completely resected under endoscopic guidance. The terms of lesion diameter in double nylon rope purse string suture group was bigger than that in single nylon rope purse string suture group, there was statistically significant difference between the two groups (P = 0.040). In the single nylon rope purse string suture group, postoperative perforation occurred in 1 case, low fever occurred in 4 cases, and mild pain in the upper abdomen occurred in 6 cases, in the double nylon rope purse string suture group, there was no postoperative perforation, 5 patients had low fever, and 6 patients had mild pain in the upper abdomen, there was no significant difference in postoperative complications between the two groups (P > 0.05). No postoperative cases were transferred to gastrointestinal surgery, and all patients were discharged smoothly. After 3 months, 7 cases in the single nylon rope purse string suture group had titanium clips and/or nylon rope residue, while 18 cases in the double nylon rope purse string suture group still had titanium clips and/or nylon rope residue, and the difference between the two groups was statistically significant (P = 0.037).Conclusion Compared with single nylon rope purse string suture, double nylon rope purse string suture can effectively close the postoperative wounds following gastric SMT with EFR ( ≥3 cm).