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金属止血夹在内镜全层切除术中的应用评价

(2014-10-22 12:28:28)

    作者单位:200032 上海,复旦大学附属中山医院内窥镜中心

    【摘要】目的 评价应用金属止血夹在内镜全层切除术中闭合胃缺损的有效性与安全性。方法 选择20096月至201012月间共62例胃黏膜下肿瘤患者,其中男22例,女40例,平均年龄58.5岁;由内镜EUSCT明确诊断为源于固有肌层、与浆膜紧密粘连的胃黏膜下肿瘤,采用内镜全层切除术治疗。完整全层切除病灶后,经内镜活检通道、直视下应用金属止血夹缝合全层缺损创面。观察术中金属止血夹缝合的成功率;术后内镜随访,评价金属止血夹缝合效果与安全性。结果 62例患者中病变位于胃底部37例,胃体部20例,胃窦部5例;1例患者病灶切除后,术中创面出血无法控制,紧急腹腔镜手术并终止研究;57例仅以金属止血夹缝合全层缺损创面;4例金属止血夹结合大网膜封堵全层缺损创面。61例完整缝合全层缺损创面者成功率100%,术后2个月均无发热腹痛等症状;平均随访4.4个月,全层缺损创面均完整愈合。结论 内镜下应用金属止血夹缝合内镜全层切除术中的全层缺损创面是一种安全、有效的方法。

    【关键词】 胃肿瘤;缝合技术;内镜全层切除术金属止血夹

    Metallic hemoclips in management of gastric defects during endoscopic full-thickness resection LIU Jing-Zheng, ZHOU Ping-hong, YAO Li-qing, XU Mei-dong, CAI Ming-yan, HU Jian-wei, QIN Wen-zheng, REN Zhong. Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Corresponding author: ZHOU Ping-hong, Email: Zhou1968@yahoo.cn

    Abstract Objective  To evaluate the clinical efficacy and safety of metallic hemoclips in the treatment of gastric defects during endoscopic full-thickness resection. Methods Patients with submucosal tumors derived from the muscularis propria and adhesion of the gastric serosa diagnosed by EUS and CT were enrolled in the study. A total of 62 patients22 males and 40 females, mean age 58.5 years, were recruited into the present study from June 2009 to December 2010, in which 37 patients were with tumors in gastric fundus20 in gastric body and 5 in antrum. All patients were treated with endoscopic full-thickness resection. After the operation, metallic hemoclips were used to close the defects through endoscopic biopsy channel. The closure success rate with metallic hemoclips were assessed. The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures. Results  All patients underwent endoscopic full-thickness resection. Uncontrollable bleeding occurred in 1 patient, who subsequently underwent emergent laparoscopic surgery and was excluded from the study. Metallic hemoclips were applied to close defects in 57 patients, and metallic hemoclips combined with omentum obstruction in 4 patients. The overall success rate was 100% in 61 patients. Endoscopic follow-up was completed in all patients in average of 4.4 months. The clinical wound healing rate was 100%. No complications such as fever, abdominal pain were found in 2 months after the procedures.  Conclusion  Application of metallic hemoclips during endoscopic full-thickness resection for gastric defects is a safe and effective technique.

    Key words Stomach neoplasms;Suture techniquesEndoscopic full-thickness resectionMetallic hemoclip

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个人资料
    周平红 单位:复旦大学附属中山医院
    所属科室:消化科
    出生:1916-12-01
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