Department of General and Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo, Japan.
Department of Surgery, Tokai University School of Medicine, Kanagawa, Japan.
Minim Invasive Ther Allied Technol. 2021 Dec;30(6):369-376. doi: 10.1080/13645706.2020.1742743. Epub 2020 Mar 20.
There are several reports on the use of the over-the-scope clip (OTSC) for gastrointestinal bleeding/fistula and endoscopic iatrogenic perforation. However, there are almost no reports on OTSC use for anastomotic leakage (AL) after colorectal cancer surgery. The purpose of this study was to evaluate the outcome of AL closure using the OTSC.
Five patients who had undergone AL after laparoscopic surgery for colorectal cancer from April 2017 to April 2019 were evaluated.
The average distance from the anal verge of the anastomosis site was 12 (5-18) cm. The average diameter of the dehiscent part was 10.9 (9.3-14.4) mm. The average number of OTSC days after the occurrence of AL was 11 (5-22). On the contrast examination immediately after OTSC, all cases were completely closed, but in the later contrast examination, only one case remained completely closed. The average incompletely closed diameter was 3.6 (2.9-5.1) mm, and the diameter of the dehiscent part was reduced in all cases. Only one patient ultimately underwent colostomy; the rest were cured with OTSC alone.
AL site closure using the OTSC after colorectal cancer surgery is a useful minimally invasive treatment when combined with appropriate drain management.
有几篇关于使用内镜下全覆膜金属夹（OTSC）治疗胃肠道出血/瘘管和内镜医源性穿孔的报道。然而，几乎没有关于 OTSC 用于结直肠癌手术后吻合口漏（AL）的报道。本研究旨在评估使用 OTSC 闭合 AL 的效果。
评估了 2017 年 4 月至 2019 年 4 月期间 5 例因腹腔镜结直肠癌手术后发生 AL 的患者。
吻合口距肛门的平均距离为 12（5-18）cm。裂开部分的平均直径为 10.9（9.3-14.4）mm。AL 发生后使用 OTSC 的平均天数为 11（5-22）天。OTSC 后即刻造影检查，所有病例均完全闭合，但在后期造影检查中，仅 1 例仍完全闭合。不完全闭合的平均直径为 3.6（2.9-5.1）mm，所有病例的裂开部分直径均缩小。仅 1 例患者最终行结肠造口术，其余患者仅用 OTSC 治愈。
结直肠癌手术后，OTSC 用于 AL 部位闭合，结合适当的引流管理，是一种有用的微创治疗方法。
