可旋转重复开闭软组织夹联合外科尼龙缝合线法闭合结直肠内镜黏膜下剥离术后缺损的临床应用价值

Clinical application value of reopenable-clip over-the-line method suturing technique for closing defects after colorectal endoscopic submucosal dissection

摘要:

目的 探讨可旋转重复开闭软组织夹联合外科尼龙缝合线法（ROLM）闭合结直肠内镜黏膜下剥离术（ESD）后黏膜缺损的临床疗效。方法 回顾性分析2024年1月－2024年6月15例在南京医科大学附属常州市第二人民医院因早期结直肠肿瘤行ESD，并采用ROLM闭合黏膜缺损患者的临床资料。观察患者病灶相关情况（病灶部位、缺损最大径和术后病理）、手术相关情况（术后缺损成功闭合率、钛夹使用数量、ROLM缝合时间和住院时间）、术后并发症发生情况和术后随访情况。结果 术后缺损成功闭合率为100%。病灶长径3.0～6.0 cm，平均（3.7±0.8）cm。缺损部位：回盲部1例，升结肠6例，横结肠肝曲1例，降结肠2例，乙状结肠3例，直肠2例。术后病理为：管状腺瘤8例，黏膜下囊肿1例，管状绒毛状腺瘤5例，胃肠道间质瘤1例。钛夹使用数量为7～20枚，中位数为11（10，13）枚。ROLM缝合时间为13～37 min，平均（19.3±6.5）min。住院时间4～9 d，平均（6.5±1.2）d。术后无出血、穿孔、感染和消化道狭窄等并发症发生。术后3～6个月复查肠镜，手术创面均愈合良好。结论 ROLM能够安全、有效地闭合结直肠ESD后黏膜缺损。值得临床推广应用。

Abstract:

Objective To explore the clinical efficacy of reopenable-clip over-the-line method (ROLM) in closing mucosal defects after endoscopic submucosal dissection (ESD) of the colon and rectum.Methods A retrospective analysis was conducted on the clinical data of 15 patients who underwent ESD due to early colorectal tumors and were treated with ROLM to close mucosal defects from January 2024 to June 2024. Observe the relevant conditions of the patient's lesion (lesion site, maximum diameter of defect and postoperative pathology), surgery-related conditions (successful defect closure rate after surgery, the number of titanium clips used, ROLM suture time and hospital stay), the occurrence of postoperative complications and postoperative follow-up.Results The successful closure rate of postoperative defects was 100%. The long diameter of the lesion ranged from 3.0 to 6.0 cm, with a mean of (3.7 ± 0.8) cm. The number of titanium clamps used is 7 to 20, with a median of 11 (10, 13). The defect was located in the ileocecal region in 1 case, the ascending colon in 6 cases, the hepatic curve of the transverse colon in 1 case, the descending colon in 2 cases, the sigmoid colon in 3 cases, and the rectum in 2 cases. Postoperative pathology showed 8 cases of tubular adenoma, 1 case of submucosal cyst, 5 cases of tubulovillous adenoma, and 1 case of gastrointestinal stromal tumor. The ROLM suture time ranged from 13 to 37 minutes, with a mean of (19.3 ± 6.5) min. The hospital stay was 4 to 9 days, with a mean of (6.5 ± 1.2) d. No complications such as bleeding, perforation, infection or digestive tract stenosis occurred after the operation. Colonoscopy was reexamined 3 to 6 months after the operation, and all the surgical wounds healed well.Conclusion ROLM can safely and effectively close mucosal defects after colorectal ESD. It is worthy of clinical promotion and application.