Abstract: Clinical application on endoscopic closure of anastomotic fistula using the over the scope clip （OTSC）                         ZHANG Juan-juan，WANG Ge-fei, CHEN Jun，et al. Department of General Surgery, General Hospital of Eastern Theater Command， Nanjing 210002, China
Corresponding author：WANG Zhi-ming，E-mail:wzmdoc@163.com
Abstract    Objective    To evaluate the efficacy and safety of over-the-scope clip（OTSC）for closure of anastomotic fistula. Methods    The clinical data of 41 patients with anastomotic fistula undergoing OTSC closure in Department of General Surgery, General Hospital of Eastern Theater Command from October 2011 to October 2020 were collected retrospectively. The clinical date including the history of surgery，the duration，location and diameter of fistula，the technical success of OTSC，complications，follow-up periods and the clinical success were recorded. Results    Forty-one patients with anastomotic fistula included 28 male and 13 female，the average age was（52.17±14.98）years，and the median duration of fistula was 118（62.5，287.5）days. Technical success was achieved in 100%. The clinical success was 60.98%（25/41）of cases after OTSC closure through contrast examination. Two patients were lost to follow-up，and 23 patients（56.10%）had no recurrent fistula in the median follow-up 186 days（144，252）. According to the clinical successful closure of fistula，patients were divided into success group（n=25）and failure group（n=16）. The duration of fistula was shorter ［76 days（56，201）vs. 216 days（97，324），P=0.028］ and the level of albumin ［（37.74±2.94）g/L vs.（34.51±4.83）g/L，P=0.025］ was higher in the success group than the failure group. Conclusion    OTSC is a safe and efficient treatment for anastomotic fistula to reduce the surgical trauma and is a potential alternative to the surgical approach. Before the OTSC placement，assessment the duration of fistula and the level of albumin are related to the successful closure of OTSC.

Key words: over-the-scope clip (OTSC), anastomotic fistula, endoscopic technique

摘要：

目的    探讨经内镜OTSC（over the scope clip）治疗吻合口瘘的安全性和疗效。方法    回顾性收集2011年10月至2020年10月至中国人民解放军东部战区总医院普通外科进行内镜下OTSC治疗的吻合口瘘病人共41例，记录病人既往手术史、病程、瘘口部位及直径、OTSC夹闭成功率、并发症、随访时间和临床疗效。结果  41例病人中男性28例，女性13例，平均年龄（52.17±14.98）岁，中位病程118 d（62.5，287.5），夹闭成功率100%。OTSC夹闭后造影检查25例（60.98%）病人瘘口愈合，其中2例出院后失访，23例（56.10%）中位随访时间186 d（144，252），期间未出现吻合口瘘。根据OTSC夹闭后造影结果将病人分为两组，成功组（n=25例）和失败组（n=16），发现治疗成功组病程［76 d（56，201）］明显短于失败组［216 d（97，324）］，P=0.028，血浆白蛋白水平（37.74±2.94）g/L）明显高于失败组（34.51±4.83）g/L），P=0.025。结论    经内镜OTSC治疗吻合口瘘安全有效，可以减少创伤，避免再次手术；术前评估吻合口瘘病程、血浆白蛋白水平有助于临床治疗成功。

关键词: OTSC, 吻合口瘘, 内镜治疗