内镜连体双金属夹在右半结肠内镜黏膜下剥离术后大创面封闭的有效性及安全性研究

doi:10.3877/cma.j.issn.2095-2015.2025.03.004

目的

评估内镜连体双金属夹（TTS-TC）在右半结肠内镜黏膜下剥离术（ESD）后大创面封闭的有效性及安全性，为ESD 术后大创面的封闭方式提供参考。

方法

回顾性选取首都医科大学附属北京友谊医院2022 年3 月1 日至2025 年2 月28 日行右半结肠ESD 且病变＞2 cm 的患者113 例，分为TTS-TC 组26 例，传统金属夹组87 例，分别统计创面闭合时间、难度及有效性，并对两组患者术后恢复进食、抗生素使用时间及住院时间进行统计分析。

结果

在创面闭合的用时上TTS-TC 组较传统金属夹组显示了更短的耗时[（12.11±3.69）min 比（13.85±3.96）min，P=0.04]，同时，应用TTS-TC 辅助闭合创面的患者仅需更少数量的金属夹即可完成闭合创面（P＜0.01）；在术后恢复方面，TTS-TC 组患者在恢复进食的时间上少于传统金属夹组（P=0.03）；初学组医师（相关系数0.83，P＜0.01）及熟练组医师（相关系数0.79，P＜0.01）均认为TTS-TC 有助于完整闭合创面，初学医师认为TTS-TC 更有利于帮助他们完整封闭创面（χ²=8.15，P=0.04）。

结论

TTS-TC 相比传统金属夹有一定的优势，可以有效降低创面闭合时间及金属夹使用数量，并缩短患者恢复进食时间。TTS-TC 可能更有助于初学者封闭较大的困难创面。

关键词: 内镜连体双金属夹, 内镜黏膜下剥离术, 创面闭合, 右半结肠

Objective

To evaluate the efficacy and safety of through-the-scope twin clip(TTS-TC) for endoscopic submucosal dissection (ESD) defect closure in the proximal colon.

Methods

A total of 113 patients underwent proximal colon ESD and had lesions >2 cm at Beijing Friendship Hospital Affiliated to Capital Medical University from March 1, 2022 to February 28, 2025 were retrospectively selected.The patients were divided into 26 cases in the TTS-TC group and 87 cases in the traditional metal clip group.The wound closure time, difficulty and effectiveness were statistically analyzed respectively,and the postoperative diet resumption time, duration of antibiotic use, and length of hospital stay of the two groups of patients were statistically analyzed.

Results

In terms of the time spent on wound closure, the TTS-TC group showed a shorter duration than the traditional metal clip group [(12.11±3.69) min vs.(13.85±3.96) min, P=0.04].Meanwhile, patients undergoing TTS-TC-assisted required fewer clips to achieve complete closure (P<0.01).In terms of postoperative recovery, the TTS-TC group showed earlier resumption of oral intake compared to the conventional clip group (P=0.03).Both novice endoscopists(coefficient 0.83, P<0.01) and experienced endoscopists (coefficient 0.79, P<0.01) agreed that TTS-TC facilitated closure.Novice endoscopists reported that TTS-TC was particularly beneficial for them(χ²=8.15, P=0.04).

Conclusion

TTS-TC has certain advantages over traditional metal clips.It can effectively reduce the defect closure time and the number of clips required, and shorten the time for patients to resume eating.TTS-TC appears to be particularly beneficial for novice endoscopists to close larger and more difficult wounds.

Key words: Through-the-scope twin clip, Endoscopic submucosal dissection, Defect closure, Proximal Colon

表1 2 组右半结肠创面修补患者一般资料及术中相关指标

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	58.08±10.46(41～77)	58.65±6.75(48～70)	0.71
性别[男,例(%)]	19(73.08)	62(71.26)	0.86
病变大小(cm, $\overset{ˉ}{x}$ ± s )	2.89±0.49	2.75±0.41	0.56
切除时间(min, $\overset{ˉ}{x}$ ± s )	73.12±15.34	73.51±10.69	0.77
闭合时间(min, $\overset{ˉ}{x}$ ± s )	12.11±3.69	13.85±3.96	0.04
闭合成功[例(%)]	26(100)	82(94.25)	0.18
术中穿孔[例(%)]	4(15.38)	8(9.20)	0.37
夹子用量(个)^#	10(8～13)	12(4～16)	＜0.01

表1 2 组右半结肠创面修补患者一般资料及术中相关指标

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
年龄(岁, $\overset{ˉ}{x}$ ± s )	58.08±10.46(41～77)	58.65±6.75(48～70)	0.71
性别[男,例(%)]	19(73.08)	62(71.26)	0.86
病变大小(cm, $\overset{ˉ}{x}$ ± s )	2.89±0.49	2.75±0.41	0.56
切除时间(min, $\overset{ˉ}{x}$ ± s )	73.12±15.34	73.51±10.69	0.77
闭合时间(min, $\overset{ˉ}{x}$ ± s )	12.11±3.69	13.85±3.96	0.04
闭合成功[例(%)]	26(100)	82(94.25)	0.18
术中穿孔[例(%)]	4(15.38)	8(9.20)	0.37
夹子用量(个)^#	10(8～13)	12(4～16)	＜0.01

表2 2 组右半结肠创面修补患者术后恢复指标

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
术后发热[例(%)]	5(19.23)	23(26.43)	0.45
术后腹痛[例(%)]	7(26.92)	25(29.73)	0.85
术后迟发穿孔[例(%)]	0(0)	2(2.29)	0.41
抗生素应用时间(d)^a	3(2～5)	3(2～7)	0.34
术后恢复进食时间(d)^a	2(2～4)	3(2～7)	0.03
术后住院时间(d)^a	3(2～6)	3(2～8)	0.54

表2 2 组右半结肠创面修补患者术后恢复指标

项目	TTS-TC 组(n=26)	金属夹组(n=87)	P值
术后发热[例(%)]	5(19.23)	23(26.43)	0.45
术后腹痛[例(%)]	7(26.92)	25(29.73)	0.85
术后迟发穿孔[例(%)]	0(0)	2(2.29)	0.41
抗生素应用时间(d)^a	3(2～5)	3(2～7)	0.34
术后恢复进食时间(d)^a	2(2～4)	3(2～7)	0.03
术后住院时间(d)^a	3(2～6)	3(2～8)	0.54

表3 初学者及熟练者对创面难度及TTS-TC 有效性的评分

组别	例数	创面封闭难度评分^a	TTS-TC有效性评分^a	相关系数	P值
初学者组	11	3(2～4)	3(2～4)	0.83	＜0.01
熟练者组	15	3(2～4)	2(2～4)	0.79	＜0.01
χ ²		0.32	8.14	-	-
P值		0.85	0.04	-	-

表3 初学者及熟练者对创面难度及TTS-TC 有效性的评分

组别	例数	创面封闭难度评分^a	TTS-TC有效性评分^a	相关系数	P值
初学者组	11	3(2～4)	3(2～4)	0.83	＜0.01
熟练者组	15	3(2～4)	2(2～4)	0.79	＜0.01
χ ²		0.32	8.14	-	-
P值		0.85	0.04	-	-

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Study of efficacy and safety of through-the-scope twin clip for endoscopic submucosal dissection defect closure in the proximal colon

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Study of efficacy and safety of through-the-scope twin clip for endoscopic submucosal dissection defect closure in the proximal colon