摘要目的:探讨内镜下手缝合(EHS)这一新技术封闭直肠内镜黏膜下剥离术(ESD)创面的可行性，以及EHS联合钛夹封闭创面的实用性。方法:这是一项前瞻性研究。2022年12月至2023年2月，由中国医学科学院肿瘤医院的2位经验丰富且接受过6次活体猪胃EHS训练的内镜医师，对20例有直肠黏膜病变或黏膜下病变的患者行ESD，然后采取EHS联合钛夹的方法封闭ESD创面，即首先通过EHS尽可能多地缝合创面，然后使用钛夹固定缝合线的尾部，最后用钛夹闭合未完全缝合的残余创面。主要观察创面的完全闭合情况和术后1个月内的延迟性出血情况。结果:20例患者ESD创面大小为2.2~3.6 cm，中位数为2.7 cm。患者的ESD创面均达到了完全闭合，其中12例(60.0%)患者实现了内镜下完全缝合，8例(40.0%)患者在EHS的基础上联合了钛夹闭合。无延迟性出血发生。结论:EHS技术闭合直肠ESD创面安全可行，EHS联合钛夹的方法同样可以有效地闭合直肠ESD创面，预防术后延迟性出血，并且更易于在临床上推广。

abstractsObjective:To explore the feasibility of endoscopic hand-suturing (EHS) for rectal defects closure after endoscopic submucosal dissection (ESD), and the clinical practicability of EHS combined with titanium clips.Methods:This is a prospective study performed by two experienced endoscopists from the Cancer Hospital, Chinese Academy of Medical Sciences who had received EHS training in sixporcine gastric ESD defects in vivo before the study. From December 2022 to February 2022, 20 patients with rectal mucosal lesions or submucosal diseases underwent ESD. Then EHS combined with titanium clips was adopted to close the rectal ESD defects. Specifically, we first sutured the defects as much as possible through EHS, then use titanium clips to fix the tail of the suture, and finally use additional titanium clips to close the residual parts of the defects that cannot be sutured. The main observational indicators were complete closure of the wound and delayed bleeding within one month after surgery. Results:In the 20 rectal cases, the size of defects ranged from 2.2 to 3.6 cm, with a median of 2.7 cm. All cases achieved complete closure without delayed bleeding, of which 12 (60.0%) were completely sutured with EHS and 8 (40.0%) required additional titanium clips to achieve complete closure after suturing.Conclusion:EHS technique is feasible and safe for rectum. EHS combined with titanium clips can also effectively close the rectal ESD defects, prevent postoperative delayed bleeding, and may be easier to be implemented in clinical practice.