热活检钳联合黏膜下注射切除结直肠微小息肉临床效果观察
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摘要
目的探讨经内镜用热活检钳切除结直肠微小息肉的临床效果。方法选择已行内镜下治疗的结直肠息肉患者320例作为研究对象,其中发现结直肠微小息肉(直径<10 mm)929枚,根据患者息肉切除的方法分为两组,热活检钳组183例(562枚息肉),氩离子凝固术组137例(367枚息肉)。比较两种治疗方法用于切除直径<10 mm的结直肠微小息肉的临床疗效。结果热活检钳组治疗直径≤6 mm的息肉切除率为100%,治疗直径<10 mm的息肉有效率为97.5%,氩离子凝固术治疗直径<10 mm的结直肠息肉有效率为86.6%;术后并发症:两组无1例术后穿孔,热活检钳组仅1例术后第3天发生出血,有2例术后轻微腹部胀痛,术后并发症发生率1.6%。氩离子凝固术组有3例出现术后出血,有5例术后轻微腹部胀痛,术后并发症发生率5.8%。结论内镜下通过热活检钳切除结直肠直径≤6 mm的微小息肉与传统的氩离子凝固术等方法相比,操作简单、疗效好、并发症少。
Objective To investigate the clinical efficacy of endoscopic resection of small colorectal polyps with thermal biopsy forceps. Methods A total of 390 patients with colorectal polyps treated during Jan. 2015 and May 2017 were selected,with 929 micro-polyps(diameter 1-10 mm) involved. The patients were divided into 2 groups according to different methods of polypectomy : thermal biopsy forceps group(n = 183, 562 polyps), and argon plasma coagulation group(n= 137,367 polyps). The clinical efficacy of the 2 groups were compared. Results In the thermal biopsy forceps group,the removal rate of polyps ≤6 mm was 100%, and the effective rate for polyps <10 mm was 97.5%. In contrast,in the argon plasma coagulation group, the effective rate for polyps <10 mm was 86.6%. No perforation developed in either group. In the thermal biopsy forceps group, bleeding occurred in 1 case and slight abdominal pain in 2 cases. The incidence of postoperative complications was 1.6%. In the argon plasma coagulation groups bleeding occurred in 3 cases and abdominal pain in 5 cases. The incidence of postoperative complications was 5.8%. Conclusion Compared with traditional argon plasma coagulation, endoscopic thermal biopsy forceps is simple and effective for the resection of colorectal polyps ≤6 mm. It is worthy of wide clinical application.
Objective To investigate the clinical efficacy of endoscopic resection of small colorectal polyps with thermal biopsy forceps. Methods A total of 390 patients with colorectal polyps treated during Jan. 2015 and May 2017 were selected,with 929 micro-polyps(diameter 1-10 mm) involved. The patients were divided into 2 groups according to different methods of polypectomy : thermal biopsy forceps group(n = 183, 562 polyps), and argon plasma coagulation group(n= 137,367 polyps). The clinical efficacy of the 2 groups were compared. Results In the thermal biopsy forceps group,the removal rate of polyps ≤6 mm was 100%, and the effective rate for polyps <10 mm was 97.5%. In contrast,in the argon plasma coagulation group, the effective rate for polyps <10 mm was 86.6%. No perforation developed in either group. In the thermal biopsy forceps group, bleeding occurred in 1 case and slight abdominal pain in 2 cases. The incidence of postoperative complications was 1.6%. In the argon plasma coagulation groups bleeding occurred in 3 cases and abdominal pain in 5 cases. The incidence of postoperative complications was 5.8%. Conclusion Compared with traditional argon plasma coagulation, endoscopic thermal biopsy forceps is simple and effective for the resection of colorectal polyps ≤6 mm. It is worthy of wide clinical application.
引文
[1]辛国秋,唐悦,唐先富.内镜下氩离子凝固术与高频电凝切除术治疗结肠息肉的疗效研究[J].局解手术学杂志,2010,19(5):392-393.XIN Guoqiu,TANG Yue,TANG Xianfu.Comparison of endoscopic argon plasma coagulation and high-frequency electroblation in the treatment of colonic ployps[J].Journal of Regional Anatomy and Operative Surgery,2010,19(5):392-393.
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[6]屈银宗,黄景荣,汪毅,等.消化道息肉内镜黏膜切除术治疗围术期预防性抗生素应用的临床研究[J].临床内科杂志,2014,31(10):712.
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[8]刘志鹏,邹利全,游斌,等.经内镜射频治疗消化道息肉869例临床分析[J].西南国防医药,2014,24(4):419-421.
[9]陈来顺.经胃镜消化道息肉高频电凝切除术的治疗及护理[J].中国实用护理杂志,2013,29(2):17.
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[12]孙华波.内镜下微波灼除术和高频电切术治疗消化道息肉效果比较[J].山东医药,2015,55(45):57-59.
[13]杨叶.糖尿病合并消化道息肉患者内镜下切除术的个体化治疗方案安全性分析[J].中国全科医学,2013,16(14):1666-1668.YANG Ye.Safety of individualized endoscopic resection programs in diabetes patients w ith gastrointestinal polyps[J].Chinese General Practice,2013,16(14):1666-1668.
[14]李璧倩,张燕,陈元龙,等.3种内镜微创手术治疗消化道息肉的近远期疗效[J].解放军医药杂志,2016,28(10):77-80.LI Biqian,ZHANG Yan,CHEN Yuanlong,et al.Shortterm and long-term effects of three kinds of endoscopic minimally invasive surgeries in treatment of gastrointestinal polyps[J].M edical&Pharmaceutical Journal of Chinese Peoples Liberation Army,2016,28(10):77-80.
[15]王莉莉,孟云,张霞,等.自护理论程序在内镜下治疗消化道息肉中的应用效果[J].国际护理学杂志,2016,35(6):779-782.
[2]余建华,劳辉.无痛结肠镜下氩气刀治疗老年人结肠息肉的临床价值[J].齐齐哈尔医学院学报,2012,33(7):873.874.YU Jianhua,LAO Hui.Clinical values of argon plasma coagulation w ith painless colonoscopy in treating elderly patients w ith colon polyps[J].Journal of Qiqihar University of M edicine,2012,33(7):873-874.
[3]徐涛,赵燕颖,孙远杰.氩离子凝固术与高频电圈套切除术治疗结肠息肉的临床疗效分析[J].慢性病学杂志,2014,15(8):615-618.XU Tao,ZHAO Yanying,SUN Yuanjie.The clinical efficacy for colon polyps using argon plasma coagulation and high-frequency electric snare resection[J].Chronic Pathematology Journal,2014,15(8):615-618.
[4]钟志民,别彩群,李园珍.内镜下高频电凝切除术与氩离子凝固术治疗大肠息肉疗效观察[J].海南医学,2012,23(8):9-10.ZHONG Zhimin,BIE Caiqun,LI Yuanzhen.Comparison of endoscopic high-frequency electroblation and APC in the treatment of large intestinal polypi[J].Hainan M edical Journal,2012,23(8):9-10.
[5]陈君,石华,姚君,等.内镜下高频电凝电切治疗消化道息肉212例临床分析[J].中国医刊,2013,48(2):70-71.
[6]屈银宗,黄景荣,汪毅,等.消化道息肉内镜黏膜切除术治疗围术期预防性抗生素应用的临床研究[J].临床内科杂志,2014,31(10):712.
[7]袁荣辉,李玲.内镜下高频电凝电切治疗消化道息肉的临床效果观察[J].医学信息,2016,29(35):298.
[8]刘志鹏,邹利全,游斌,等.经内镜射频治疗消化道息肉869例临床分析[J].西南国防医药,2014,24(4):419-421.
[9]陈来顺.经胃镜消化道息肉高频电凝切除术的治疗及护理[J].中国实用护理杂志,2013,29(2):17.
[10]Lim TR,Mahesh V,Singh S.Endoscopic mucosal resectionof colorectalpolyps in typical UK hospitals[J].World J Gastroenterol,2010,16(42):5324-5328.
[11]程亚军,仇彬彬,周庆海,等.内镜射频治疗消化道息肉的手术配合及护理[J].蚌埠医学院学报,2013,38(9):1205-1207.
[12]孙华波.内镜下微波灼除术和高频电切术治疗消化道息肉效果比较[J].山东医药,2015,55(45):57-59.
[13]杨叶.糖尿病合并消化道息肉患者内镜下切除术的个体化治疗方案安全性分析[J].中国全科医学,2013,16(14):1666-1668.YANG Ye.Safety of individualized endoscopic resection programs in diabetes patients w ith gastrointestinal polyps[J].Chinese General Practice,2013,16(14):1666-1668.
[14]李璧倩,张燕,陈元龙,等.3种内镜微创手术治疗消化道息肉的近远期疗效[J].解放军医药杂志,2016,28(10):77-80.LI Biqian,ZHANG Yan,CHEN Yuanlong,et al.Shortterm and long-term effects of three kinds of endoscopic minimally invasive surgeries in treatment of gastrointestinal polyps[J].M edical&Pharmaceutical Journal of Chinese Peoples Liberation Army,2016,28(10):77-80.
[15]王莉莉,孟云,张霞,等.自护理论程序在内镜下治疗消化道息肉中的应用效果[J].国际护理学杂志,2016,35(6):779-782.