Objective: To analyze the efficacy of alternate titanium clip closure in preventing postoperative complications for patients with gastric mucosal lesions after endoscopic submucosal dissection (ESD). Methods: Clinical data of patients with gastric mucosal lesions who underwent ESD in the Department of Gastroenterology, Zhongda Hospital, Southeast University, were retrospectively collected from January 1, 2013 to August 31, 2023. According to the postoperative wound closure status, the patients were divided into completely closed group (complete closure of ESD wounds using alternate titanium clip closure), partially closed group (partial closure of ESD wounds), and unclosed group (without use of clips for treatment of ESD wounds). The incidence of postoperative complications as well as wound healing at 1 month and 3 months after surgery were compared among three groups, and the factors related to delayed bleeding after ESD for gastric mucosal lesions were analyzed through multiple logistic regression analysis. Results: A total of 846 patients were included, 430 cases in the completely closed group, including 300 males and 130 females, age [M (Q1, Q3)] was 65(56, 72) years old; one hundred and nine cases in unclosed group, including 78 males and 31 females, aged 66 (60, 71) years; and 307 cases in the partially closed group, including 214 males and 93 females, aged 66 (59, 71) years. The difference in the rate of delayed postoperative bleeding between the completely closed group [2.1% (9/430)] and the unclosed group [5.5% (6/109)] was not statistically significant (P=0.072), but both were lower than that of the partially closed group [9.4% (29/307), P<0.05)]. Further stratified analysis showed that, for the lesions located in the lower 1/3 of the stomach, the rate of postoperative bleeding was lower in the completely closed group than in the partially closed and unclosed groups [0.9% (2/222) vs 11.4% (4/35) vs 9.5% (7/74), respectively, P<0.001]. For lesions≥50 mm in length, the rate of postoperative bleeding was lower in the completely closed group than that in the partially closed and unclosed group[0 vs 11.8% (2/17) vs 20.5% (15/73), respectively, P=0.004]. The incidence of postoperative abdominal pain in the completely closed group [84.2% (363/430)] was lower than that in the unclosed group [97.2% (106/109)] and the partially closed group [95.4% (293/307), both P<0.001)]. The score of postoperative abdominal pain in the completely closed group [0 (0, 1)], was lower than that in the unclosed group [3 (2, 3)], and that in the partially closed group [2 (1, 3)] (both P<0.001). The wound healing rate of the completely closed group [80% (176/220)] was higher than that of the unclosed group [52.3% (33/63)] and the partially closed group [52.2% (83/159)] at 1 month postoperatively (both P<0.001); the healing rate of all three groups reached 100% at 3 months postoperatively. Multiple logistic regression analysis showed that the presence of ulcers or scars on the surface of the lesion (OR=2.930, 95%CI:1.503-5.712, P=0.002), and the diameter (OR=1.031, 95%CI:1.015-1.047,P<0.001) were related factors for postoperative bleeding. Conclusions: The alternate titanium clip closure surgery can reduce postoperative abdominal pain and shorten wound healing time in patients with gastric mucosal lesions after ESD surgery. The risk of postoperative bleeding can be reduced for lesions with a diameter≥50 mm and located in the lower 1/3 of the stomach.
目的： 分析交替钛夹夹闭术预防胃黏膜病变内镜下黏膜剥离术（ESD）后并发症的效果。 方法： 回顾性收集2013年1月1日至2023年8月31日于东南大学附属中大医院消化科行ESD治疗的胃黏膜病变患者的临床资料，按照术后创面闭合情况，分为完全闭合组（使用交替钛夹夹闭术完全封闭ESD术后创面）、部分闭合组（使用钛夹部分处理ESD术后创面）、不闭合组（未使用钛夹封闭或处理ESD术后创面）。比较3组术后并发症发生率及术后1、3个月创面愈合情况，通过多因素logistic回归分析胃黏膜病变ESD术后迟发性出血的相关因素。 结果： 共纳入846例患者，完全闭合组共430例，男300例，女130例，年龄［M（Q1，Q3）］为65（56，72）岁；不闭合组共109例，其中男78例，女31例，年龄66（60，71）岁；部分闭合组共307例，其中男214例，女93例，年龄66（59，71）岁。完全闭合组［2.1%（9/430）］与不闭合组［5.5%（6/109）］术后迟发性出血率差异无统计学意义（P=0.072），但均低于部分闭合组［9.4%（29/307），P<0.05）］；进一步分层分析显示，位于胃下1/3的病灶，完全闭合组术后出血率低于部分闭合组和不闭合组［分别为0.9%（2/222）比11.4%（4/35）比9.5%（7/74），P<0.001］；长径≥50 mm的病灶，完全闭合组术后出血率低于部分闭合组和不闭合组［分别为0比11.8%（2/17）比20.5%（15/73），P=0.004］。完全闭合组［84.2%（363/430）］术后腹痛发生率低于不闭合组［97.2%（106/109）］及部分闭合组［95.4%（293/307），均P<0.001］；完全闭合组术后腹痛评分［M（Q1，Q3）］为0（0，1）分，低于不闭合组的3（2，3）分和部分闭合组的2（1，3）分（均P<0.001）。术后1个月完全闭合组创面愈合率［80%（176/220）］高于不闭合组［52.3%（33/63）］及部分闭合组［52.2%（83/159），均P<0.001）］；术后3个月3组愈合率均为100%。多因素logistic回归分析显示，病灶表面存在溃疡或疤痕（OR=2.930，95%CI：1.503~5.712，P=0.002）、病灶长径（OR=1.031，95%CI：1.015~1.047，P<0.001）为术后出血的相关因素。 结论： 使用交替钛夹夹闭术完全闭合胃黏膜病变ESD术后创面能减轻患者术后腹痛，缩短创面愈合时间。对于长径≥50 mm及位于胃下1/3的病灶，该技术可降低术后出血风险。.