2026 年第 5 期 第 21 卷

如何使学员尽快掌握三臂夹内镜术后创面闭合技术

How to help trainees master tri-arm clip wound closure technique after endoscopic surgery as soon as possible

作者：陈雪张杰

英文作者：Chen Xue Zhang Jie

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：结直肠病变；三臂夹；创面闭合；培训教学；内镜黏膜下剥离术

英文关键词：Colorectallesions;Three-armclip;Woundclosure;Trainingandteaching;Endoscopicsubmucosaldissection

• 摘要：

• 目的 探讨如何帮助学员快速掌握三臂夹用于结直肠病变内镜黏膜下剥离术（ESD）术后创面的闭合技术。方法 选取2024年9月至2025年9月于首都医科大学附属北京安贞医院消化内科接受 ESD 规范化培训的8名学员作为研究对象。采用理论授课、视频教学和现场观摩学习、动物模型操作练习及手把手带教的阶梯式培训模式，评估学员独立完成三臂夹创面闭合操作的能力；记录学员运用三臂夹联合普通金属夹进行创面闭合的操作时长，以及患者术后出血、穿孔、感染等并发症的发生情况。培训结束后通过问卷调查收集学员对本次培训的评价与反馈。结果 本次共纳入8名参训学员，均完成全部阶梯式培训流程。所有学员均可独立完成三臂夹 ESD 术后创面闭合操作。纳入操作的创面直径为（21±8）mm，学员采用三臂夹联合普通金属夹完成创面闭合的平均操作时长为（20±11）min。所有患者术后均未出现出血、穿孔、感染等相关并发症。参训学员均反馈本次培训效果显著，三臂夹创面闭合技术可有效提升其 ESD 术后创面的处理能力，李克特量表调查问卷培训的整体价值项得分为（4.8±0.5）分。结论 采用阶梯式培训模式，能够帮助学员快速掌握三臂夹内镜术后创面闭合技术。三臂夹应用于ESD创面闭合高效且安全，尤其适用于创面面积较大、位于特殊解剖部位、术中存在肌层损伤或可疑穿孔、出血风险较高的创面闭合。

• Objective To explore how to help trainees quickly master the technique of tri-arm clip for wound closure after endoscopic submucosal dissection (ESD) of colorectal lesions. Methods Eight trainees who received standardized ESD training in the Department of Gastroenterology, Beijing Anzhen Hospital, Capital Medical University from September 2024 to September 2025 were selected as subjects. A stepwise training model including theoretical lectures, video teaching, on-site observation, animal model practice and hands-on tutoring was adopted. The ability of trainees to independently complete wound closure with tri-arm clips was evaluated. The operation time of wound closure using tri-arm clips combined with ordinary metal clips and the incidence of postoperative complications such as bleeding, perforation and infection were recorded. After training, questionnaires were used to collect trainees′ evaluation and feedback. Results A total of 8 trainees were enrolled and all completed the whole stepwise training process. All trainees could independently complete wound closure with tri-arm clips after ESD. The diameter of the included wounds was (21±8)mm, and the average operation time for trainees to complete wound closure with tri-arm clips combined with ordinary metal clips was (20±11)min. No postoperative complications such as bleeding, perforation or infection occurred in any patient. All trainees reported that the training effect was significant, and the tri-arm clip wound closure technique could effectively improve their ability to manage wounds after ESD. The overall value score of the training in the Likert scale questionnaire was (4.8±0.5). Conclusion The stepwise training model can help trainees quickly master the tri-arm clip wound closure technique after endoscopic surgery. Tri-arm clip is efficient and safe for ESD wound closure, especially suitable for wounds with large area, special anatomical location, intraoperative muscular layer injury or suspected perforation, and high bleeding risk.