隐匿性保险杠综合征的治疗：一项纳入160例病例的回顾性多中心研究
Treatment of the Buried Bumper Syndrome: A Retrospective Multicenter Study With Inclusion of 160 Cases.
作者信息
Steinbrück Ingo, Pohl Jürgen, Friesicke Matthias, Grothaus Johannes, von Hahn Thomas, Drews Jan, Faiss Siegbert, Kuellmer Armin, Otto Helge, Allgaier Hans-Peter
机构信息
Department of Medicine and Gastroenterology, Protestant Deaconess Hospital (Evangelisches Diakoniekrankenhaus) Freiburg, Academic Teaching Hospital, University of Freiburg.
Department of Gastroenterology, Asklepios Clinic Altona, Academic Teaching Hospital University of Hamburg, Hamburg.
出版信息
J Clin Gastroenterol. 2025 Apr 1;59(4):335-343. doi: 10.1097/MCG.0000000000002018.
BACKGROUND AND GOALS
The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques.
METHODS
The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality.
RESULTS
The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% ( P <0.01), rates of overall technical success 100% and 88.3% ( P =0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) ( P <0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes ( P <0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%.
CONCLUSIONS
Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.
背景与目标
埋藏式吻合器综合征（BBS）的治疗颇具难度。这项回顾性多中心研究旨在分析治疗方法，重点关注内镜技术的有效性和安全性。
方法
对所有治疗方法进行分析，并比较乳头切开刀技术（PT）和基于针刀的非乳头切开刀技术（NPT）。主要终点是单次操作的技术成功率，次要终点包括总体技术成功率、治疗次数及持续时间、严重不良事件（SAE）和死亡率。
结果
2003年至2021年期间诊断的160例BBS患者，主要治疗方法中，60例（37.5%）采用NPT，43例（26.9%）采用PT，40例（25.0%）采用推/拉技术（PPT），9例（5.6%）未取出，7例（4.4%）接受剖腹手术，1例（0.6%）接受外部切开。PT和NPT的单次操作技术成功率分别为95.5%和45.0%（P<0.01），总体技术成功率分别为100%和88.3%（P = 0.02），平均治疗次数及持续时间分别为1.05（±0.21）次与1.70（±0.91）次（P<0.01）以及32.17（±21.73）分钟与98.00（±62.28）分钟（P<0.01）。PT和NPT在SAE（15.9%对25.0%）和死亡率（2.3%对1.7%）方面无显著差异。对于PPT、剖腹手术和外部切开，单次操作技术成功率和总体技术成功率均为100%，SAE发生率分别为2.5%、50.0%和0%，死亡率分别为0%、10.0%和0%。
结论
在大多数情况下，BBS的内镜治疗是首选，采用PPT取出不完全的吻合器。对于完全性吻合器，PT似乎比NPT更有效。
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