【摘要】：目的探討單鉗道內(nèi)鏡跨越式荷包縫合法在封閉醫(yī)源性胃腸黏膜缺損中的臨床價(jià)值。方法回顧性分析2015年4月至2016年8月我科消化內(nèi)鏡中心對(duì)胃腸道病變行內(nèi)鏡黏膜下剝離術(shù)(endoscopic submucosal dissection,ESD)形成較大創(chuàng)面的患者資料,其中42例采用我科自創(chuàng)的單鉗道內(nèi)鏡跨越式荷包縫合(研究組),余21例創(chuàng)面曠置(對(duì)照組),比較兩組術(shù)后并發(fā)癥發(fā)生情況及創(chuàng)面愈合情況,評(píng)估單鉗道內(nèi)鏡跨越式荷包縫合法的可行性、安全性和療效。結(jié)果研究組ESD術(shù)后創(chuàng)面直徑(1.4±0.8)cm,對(duì)照組創(chuàng)面直徑(1.2±1.0)cm,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。研究組單鉗道內(nèi)鏡跨越式荷包縫合創(chuàng)面,每個(gè)患者平均使用金屬夾4~6個(gè),尼龍繩1~2個(gè),創(chuàng)面縫合滿意,成功率100%,術(shù)后5例(5/42,11.9%)出現(xiàn)一過性發(fā)熱,4例(4/42,9.5%)出現(xiàn)腹痛、腹脹;對(duì)照組中4例(4/21,19.0%)出現(xiàn)發(fā)熱,6例(6/21,28.6%)出現(xiàn)腹痛、腹脹,2例(2/21,9.5%)術(shù)后創(chuàng)面出血,兩組差異有統(tǒng)計(jì)學(xué)意義(P0.05);研究組住院時(shí)間(4.52±1.27)d,對(duì)照組住院時(shí)間(6.94±1.53)d,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后隨訪,研究組1個(gè)月后創(chuàng)面均愈合良好,可見疤痕形成,有6例患者金屬夾及尼龍繩未脫落,2個(gè)月后復(fù)查內(nèi)鏡,創(chuàng)面光滑,愈合良好,僅1例患者金屬夾及尼龍繩未脫落;對(duì)照組1個(gè)月后隨訪,3例患者創(chuàng)面形成巨大潰瘍,2個(gè)月后復(fù)查內(nèi)鏡,其中1例患者潰瘍面愈合較差。結(jié)論單鉗道內(nèi)鏡跨越式荷包縫合法修補(bǔ)ESD術(shù)后較大創(chuàng)面術(shù)后并發(fā)癥率低、住院時(shí)間短、創(chuàng)面愈合好;該法安全而有效,可廣泛應(yīng)用于臨床。
[Abstract]:Objective to evaluate the clinical value of single clamp endoscopy in the treatment of iatrogenic gastrointestinal mucosal defect. Methods from April 2015 to August 2016, the data of patients with large wounds caused by endoscopic submucosal dissection (endoscopic submucosal dissection,ESD) in digestive endoscopy center of our department were analyzed retrospectively. Among them, 42 cases were treated with single-clamp endoscope suture (study group), and 21 cases were left out (control group). The complications and wound healing were compared between the two groups. To evaluate the feasibility, safety and efficacy of single-clamp endoscopic leapfrog purse suture. Results there was no significant difference in wound diameter (1.4 鹵0.8) cm, control group (1.2 鹵1.0) cm, in the study group after ESD (P0.05). The patients in the study group were treated with an average of 4 ~ 6 metal clips and 1 ~ 2 nylon ropes. The wound suture was satisfactory, and the success rate was 100. 5 cases (5 / 42, 11.9%) had transient fever after operation. Abdominal pain and distension were found in 4 cases (4 / 42%). In the control group, 4 cases (4 / 21 鹵19.0%) developed fever, 6 cases (6 / 21%, 28.6%) developed abdominal pain and abdominal distension, 2 cases (2 / 21 鹵9.5%) postoperative wound bleeding, the difference between the two groups was statistically significant (P0.05). The hospitalization time of the study group was (4.52 鹵1.27) days, the control group was (6.94 鹵1.53) days, the difference was statistically significant (P0.05). The wound healed well after 1 month in the study group, and the scar formation was observed in the study group. Six patients with metal clip and nylon rope did not fall off. After 2 months, the wound was smooth and healed well. Only one patient with metal clip and nylon rope did not fall off. The patients in the control group were followed up for 1 month, 3 patients developed giant ulcer, and 2 months later, the ulcer surface of 1 patient was not healed well. Conclusion this method is safe and effective and can be widely used in clinic because of its low complication rate, short hospital stay and good wound healing.
【作者單位】： 重慶市涪陵中心醫(yī)院消化科;
【分類號(hào)】：R656

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 胡建敏;王海明;;闌尾切除殘端荷包縫合與單純結(jié)扎的療效比較[J];臨床醫(yī)學(xué);1986年02期

2 鄧秋香;;吻合器痔上黏膜環(huán)切術(shù)荷包縫合深度對(duì)療效的影響[J];南華大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2010年04期

3 喻德洪,聞?wù)渍?陳慶蘭;闌尾荷包縫合鉗[J];第二軍醫(yī)大學(xué)學(xué)報(bào);1984年04期

4 程世平,賈全安,任光學(xué),高志強(qiáng),蔡宏俊,周德清,王樂群;可拆除雙活結(jié)無張力荷包縫合法在恥骨上前列腺切除術(shù)中的應(yīng)用[J];臨床泌尿外科雜志;2000年06期

5 李維燦;改良活扣荷包縫合止血法在恥骨上前列腺摘除術(shù)中的應(yīng)用[J];臨床泌尿外科雜志;1998年06期

6 王洪貴,郝支軍,刁元浩,張新明,張志明,閻文祥,王金銀,王毓珠,強(qiáng)生舜,宋廣太,肖湘,鄭南松,趙世才,張鐵山,蔡長(zhǎng)友;各種結(jié)扎法和/或荷包縫合法[J];實(shí)用外科雜志;1988年05期

7 李云新;;荷包縫合不同高度對(duì)吻合器痔上黏膜環(huán)切術(shù)治療內(nèi)痔療效及并發(fā)癥的影響[J];中國(guó)醫(yī)療前沿;2011年08期

8 涂蒼慨,涂登炎;嬰幼兒腹股溝斜疝修補(bǔ)術(shù)的改進(jìn)[J];安徽中醫(yī)學(xué)院學(xué)報(bào);1996年04期

9 孫志剛,韓巖,郭樹忠,魯開化;四點(diǎn)荷包縫合圓形皮膚病灶的實(shí)驗(yàn)研究[J];華北國(guó)防醫(yī)藥;2002年06期

10 陳規(guī)劃;改良荷包縫合法在胰空腸套入吻合中的應(yīng)用(英)[J];國(guó)外醫(yī)學(xué).外科學(xué)分冊(cè);1994年06期

相關(guān)會(huì)議論文 前5條

1 安少雄;苗春紅;;單荷包縫合預(yù)防吻合器痔上黏膜環(huán)切術(shù)中出血的臨床研究[A];北京結(jié)直腸肛門病學(xué)術(shù)交流會(huì)暨盧克捷學(xué)術(shù)思想研討會(huì)論文集[C];2012年

2 楊亞益;;荷包縫合皮膚圓形病灶在臨床中的運(yùn)用[A];2006年浙江省整形外科與醫(yī)學(xué)美容學(xué)術(shù)會(huì)議論文匯編[C];2006年

3 高乃榮;石欣;;胰腸插入荷包縫合預(yù)防胰瘺的臨床觀察[A];中華醫(yī)學(xué)會(huì)第十一屆全國(guó)胰腺外科學(xué)術(shù)研討會(huì)論文匯編[C];2006年

4 馬盈盈;袁學(xué)剛;楊向東;張平副;易貴華;;單荷包縫合在PPH術(shù)中的臨床應(yīng)用體會(huì)[A];中華中醫(yī)藥學(xué)會(huì)第十二次大腸肛門病學(xué)術(shù)會(huì)議論文匯編[C];2006年

5 王志民;;波浪式荷包縫合法在PPH治療混合痔中應(yīng)用[A];中醫(yī)肛腸理論與實(shí)踐——中華中醫(yī)藥學(xué)會(huì)肛腸分會(huì)成立三十周年紀(jì)念大會(huì)暨二零一零年中醫(yī)肛腸學(xué)術(shù)交流大會(huì)論文匯編[C];2010年

相關(guān)重要報(bào)紙文章 前1條

1 記者 張曄 通訊員 范潔 劉超;我專家獨(dú)創(chuàng)“荷包縫合技術(shù)”替代傳統(tǒng)針線縫合法[N];科技日?qǐng)?bào);2014年

相關(guān)碩士學(xué)位論文 前3條

1 王鵬飛;荷包縫合方法在乳腺癌改良根治術(shù)切口縫合中的應(yīng)用[D];廣西醫(yī)科大學(xué);2016年

2 袁保;降低荷包縫合高度施行PPH術(shù)的臨床研究[D];南京中醫(yī)藥大學(xué);2012年

3 岳朝馳;兩種不同荷包縫合高度的PPH術(shù)治療混合痔的臨床對(duì)照研究[D];成都中醫(yī)藥大學(xué);2009年

，

本文編號(hào)：2395242