尼龙绳结扎装置在内镜下荷包缝合过程中的常见问题分析及应对策略

目的 总结尼龙绳结扎装置在内镜下荷包缝合过程中出现的问题事件并分析其原因，从而改进和探索尼龙绳结扎装置使用过程中的技巧及策略。方法 回顾性分析2017年4月－2020年12月该院消化内镜中心99例行上消化道内镜下荷包缝合患者的手术过程，总结尼龙绳结扎装置在使用过程中出现的问题事件及其原因。结果 共总结出问题事件21次，包括外鞘管前端褶皱10次、结扎环脱钩5次、结扎环无法释放2次、结扎环断开2次、结扎环塞向前移动2次。结果显示，内镜类型和缝合镜式是问题事件发生的影响因素，且单腔镜操作、倒镜缝合比双腔镜、正镜缝合更容易发生问题事件，病变的位置不是问题事件发生的影响因素，差异无统计学意义（P > 0.05）。结论 通过分析人为因素、创面位置因素、装置质量因素等问题事件的原因，提出相应的对策，从而减少和避免不必要的问题事件，提高手术效率。

Analysis of common problems and countermeasures of nylon rope ligation device in endoscopic purse string suture

Objective Summarize and analyze the problems and causes of nylon rope ligation device in endoscopic purse string suture, so as to improve and explore the skills and strategies in the use of nylon rope ligation device.Method The operation process, problems and causes of nylon rope ligation device in the use of 99 patients with upper gastrointestinal purse string suture from April 2017 to December 2020 were analyzed retrospectively.Results 21 problem events were summarized, including 10 folds at the front end of the outer sheath, 5 decoupling of the ligation ring, 2 failure to release the ligation ring, 2 disconnection of the ligation ring and 2 forward movement of the ligation ring plug. The results showed that endoscopic type and suture type were the influencing factors of problem events, and single lumen operation and inverted mirror suture were more likely to occur problem events than double lumen and positive mirror suture. The location of lesions was not the influencing factor of problem events, and the difference was not statistically significant (P > 0.05).Conclusion By analyzing the causes of human factors, wound location factors and device quality factors, the corresponding countermeasures are put forward, so as to reduce and avoid unnecessary problem events and improve the operation efficiency.