抗生素对结直肠息肉氩离子凝固术及电凝电切术后炎性指标的影响
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摘要
目的探讨抗生素对结直肠息肉氩离子凝固术及电凝电切术后炎性指标的影响。方法采取前瞻性随机对照研究方法,选择2014-01至2015-12医院消化内科收治的58例结直肠息肉治疗患者,随机分为抗生素组(28例)及非抗生素组(30例)。于术前,术后1、3 d测定血浆内毒素、降钙素原及C-反应蛋白水平。结果 58例治疗后均未出血及穿孔,术后9例出现腹痛、腹胀不适(15.5%),12~24 h症状基本消失。抗生素组患者治疗后出现低热1例(3.6%),发热时间为术后8 h左右,非抗生素组患者治疗后出现发热4例(13.3%),均为低热,发热时间为术后7~14 h,两组发热率差异有统计学意义(P<0.05)。两组治疗后1、3 d与术前比较,血浆内毒素、血浆降钙素原、C-反应蛋白水平变化差异均无统计学意义。结论结直肠息肉氩离子凝固术及电凝电切术治疗在整体上是安全的,治疗后炎性指标基本正常,不支持应用抗生素。
Objective To explore the effect of antibiotics on inflammatory markers of colorectal polyps after surgery by means of argon plasma coagulation and electrocoagulation. Methods In this prospective study,58 cases of patients with colorectal polyps received the endoscopic treatment. These patients were randomly divided into the antibiotic group( 28 cases) and the non-antibiotic group( 30 cases). The levels of plasma endotoxin,procalcitonin and C-reactive protein were measured before endoscopic treatment and one day,three days after treatment. Results No hemorrhage or perforation occurred in any of the cases after postpolypectom. The abdominal pain and abdominal distension occurred in nine cases( 15. 5%) after postpolypectomy,but the symptoms disappeared in twelve to twenty-four hours. Low fever after polypectomy occurred in one case( 3. 6%) in the antibiotic group,and the interval between polypectomy and the occurrence of fever was eight hours. Fever occurred after polypectomy in four of the thirty cases( 13. 3%)in the non-antibiotic group,and the median interval was seven to fourteen hours. There was significant difference between the two groups in the incidence of fever( P < 0. 05). The difference in plasma levels of endotoxin,procalcitonin and C-reactive protein was not statistically significant one day and three days after endoscopic treatment compared with preoperative levels in the two groups.Conclusions Colorectal polypectomy using argon plasma coagulation techniques and electric coagulation is considered safe. The inflammatory markers after endoscopic treatment are basically normal. Antibiotics should be used with caution.
Objective To explore the effect of antibiotics on inflammatory markers of colorectal polyps after surgery by means of argon plasma coagulation and electrocoagulation. Methods In this prospective study,58 cases of patients with colorectal polyps received the endoscopic treatment. These patients were randomly divided into the antibiotic group( 28 cases) and the non-antibiotic group( 30 cases). The levels of plasma endotoxin,procalcitonin and C-reactive protein were measured before endoscopic treatment and one day,three days after treatment. Results No hemorrhage or perforation occurred in any of the cases after postpolypectom. The abdominal pain and abdominal distension occurred in nine cases( 15. 5%) after postpolypectomy,but the symptoms disappeared in twelve to twenty-four hours. Low fever after polypectomy occurred in one case( 3. 6%) in the antibiotic group,and the interval between polypectomy and the occurrence of fever was eight hours. Fever occurred after polypectomy in four of the thirty cases( 13. 3%)in the non-antibiotic group,and the median interval was seven to fourteen hours. There was significant difference between the two groups in the incidence of fever( P < 0. 05). The difference in plasma levels of endotoxin,procalcitonin and C-reactive protein was not statistically significant one day and three days after endoscopic treatment compared with preoperative levels in the two groups.Conclusions Colorectal polypectomy using argon plasma coagulation techniques and electric coagulation is considered safe. The inflammatory markers after endoscopic treatment are basically normal. Antibiotics should be used with caution.
引文
[1]中华人民共和国国家卫生和计划生育委员会医政医管局中华医学会肿瘤学分会.结直肠癌诊疗规范(2015年版)[J].中国实用外科杂志,2015,35(11):1177-1191.
[2]Calderwood A H,Schroy P C,David A,et al.Boston Bowel Preparation Scale scores provide a standardized definition of“adequate”for describing bowel cleanliness[J].Gastrointest Endosc,2014,80(2):269-276.
[3]Tan Tao,Qu Yawei,Shu Juan,et al.Diagnostic value of high-resolution micro-endoscopy for the classification of colon polyps[J].World J Gastroenterol,2016,22(5):1869-1876.
[4]Paggi S,Radaelli F,Repici A,et al.Advances in the removal of diminutive colorectal polyps[J].Expert Rev Gastroenterol Hepatol,2015,9(2):237-244.
[5]Anderloni A,Jovani M,Hassan C,et al.Advances,problems,and complications of polypectomy[J].Clin Exp Gastroenterol,2014,7:285-296.
[6]Seung-Hoon L,Kyung-Jo K,Dong-Hoon Y,et al.Postpolypectomy fever,a rare adverse event of polypectomy:nested case-control study[J].Clin Endosc,2014,47(3):236-241.
[7]Hyung Wook K.What is different between postpolypectomy fever and postpolypectomy coagulation syndrome?[J].Clin Endosc,2014,47(3):205-206.
[8]Cha J M,Lim K S,Lee S H,et al.Clinical outcomes and risk factors of post-polypectomy coagulation syndrome:a multicenter,retrospective,case-control study[J].Endoscopy,2013,45(3):202-207.
[2]Calderwood A H,Schroy P C,David A,et al.Boston Bowel Preparation Scale scores provide a standardized definition of“adequate”for describing bowel cleanliness[J].Gastrointest Endosc,2014,80(2):269-276.
[3]Tan Tao,Qu Yawei,Shu Juan,et al.Diagnostic value of high-resolution micro-endoscopy for the classification of colon polyps[J].World J Gastroenterol,2016,22(5):1869-1876.
[4]Paggi S,Radaelli F,Repici A,et al.Advances in the removal of diminutive colorectal polyps[J].Expert Rev Gastroenterol Hepatol,2015,9(2):237-244.
[5]Anderloni A,Jovani M,Hassan C,et al.Advances,problems,and complications of polypectomy[J].Clin Exp Gastroenterol,2014,7:285-296.
[6]Seung-Hoon L,Kyung-Jo K,Dong-Hoon Y,et al.Postpolypectomy fever,a rare adverse event of polypectomy:nested case-control study[J].Clin Endosc,2014,47(3):236-241.
[7]Hyung Wook K.What is different between postpolypectomy fever and postpolypectomy coagulation syndrome?[J].Clin Endosc,2014,47(3):205-206.
[8]Cha J M,Lim K S,Lee S H,et al.Clinical outcomes and risk factors of post-polypectomy coagulation syndrome:a multicenter,retrospective,case-control study[J].Endoscopy,2013,45(3):202-207.