三种圈套器切除术治疗结直肠小息肉的疗效分析
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摘要
目的探讨内镜下圈套器切除术治疗结直肠小息肉的优选术式。方法从2017年8月—2018年2月接受结肠镜检查的患者中筛选90例患者,随机分为3组:间接冷圈套切除术(CSP)组30例(42枚息肉)、直接CSP组30例(41枚息肉)和热圈套切除术(HSP)组30例(54枚息肉)。间接CSP组采用黏膜下注射0.9%NaCl溶液抬举息肉后圈套器机械勒除息肉,直接CSP组采用圈套器机械勒除息肉,HSP组采用黏膜下注射0.9%NaCl溶液抬举息肉后圈套器高频电切除息肉。观察并对比3种手术方式的即刻出血发生率、迟发出血发生率、穿孔发生率、息肉切除时间、息肉完整切除率等。结果间接CSP组、直接CSP组和HSP组即刻出血发生率分别为43.3%(13/30)、46.7%(14/30)、16.7%(5/30),3组间两两比较差异均有统计学意义(P值均<0.05),直接CSP组即刻出血发生率最高。间接CSP组和直接CSP组均未发生迟发出血,HSP组迟发出血的发生率为10.0%(3/30),HSP组的迟发出血率显著高于其他两组(P值均<0.05)。间接CSP组内镜下息肉完整切除率为88.1%(37/42),直接CSP组为92.7%(38/41),HSP组为100.0%(54/54),HSP组的完整切除率显著高于其他两组(P值均<0.05)。结论 HSP具有较好的完整切除率,但有迟发出血的风险,CSP即刻出血风险较大。
Objective To explore the optimal surgical method of endoscopic snare resection for small colorectal polyps. Methods Ninety patients with colorectal polyps who received colonscopy between August 2017 and February 2018 were randomly divided into three groups. Indirect cold snare polypectomy was performed in 30 patients with 42 polyps. Direct cold snare polypectomy was applied in 30 patients with 41 polyps. And hot snare polypectomy were used in 30 patients with 54 polyps. Immediate bleeding, post-polypectomy bleeding, perforation, operation time and complete resection rate were observed and recorded. Results The incidence rates of immediate bleeding were 43.3%(13/30), 46.7%(14/30) and 16.7%(5/30) in indirect cold snare polypectomy, direct cold snare polypectomy and hot snare polypectomy groups, respectively. There were significant differences in the incidence of immediate bleeding between groups(all P<0.05). Post-polypectomy bleeding was found in neither indirect nor direct cold snare polypectomy. The incidence of post-polypectomy bleeding was 10.0% in hot snare polypectomy which was significantly increased compared with the other two groups(both P<0.05). The rate of complete resection were 88.1%(37/42), 92.7%(38/41) and 100.0%(54/54) in indirect cold snare polypectomy, direct cold snare polypectomy and hot snare polypectomy groups, respectively. The differences among the three groups were statistically significant(all P<0.05). Conclusion The hot snare polypectomy can significantly increase the complete resection rate, but there is a risk of post-polypectomy bleeding. The risk of immediate bleeding of cold snare polypectomy is higher than hot snare polypectomy.
Objective To explore the optimal surgical method of endoscopic snare resection for small colorectal polyps. Methods Ninety patients with colorectal polyps who received colonscopy between August 2017 and February 2018 were randomly divided into three groups. Indirect cold snare polypectomy was performed in 30 patients with 42 polyps. Direct cold snare polypectomy was applied in 30 patients with 41 polyps. And hot snare polypectomy were used in 30 patients with 54 polyps. Immediate bleeding, post-polypectomy bleeding, perforation, operation time and complete resection rate were observed and recorded. Results The incidence rates of immediate bleeding were 43.3%(13/30), 46.7%(14/30) and 16.7%(5/30) in indirect cold snare polypectomy, direct cold snare polypectomy and hot snare polypectomy groups, respectively. There were significant differences in the incidence of immediate bleeding between groups(all P<0.05). Post-polypectomy bleeding was found in neither indirect nor direct cold snare polypectomy. The incidence of post-polypectomy bleeding was 10.0% in hot snare polypectomy which was significantly increased compared with the other two groups(both P<0.05). The rate of complete resection were 88.1%(37/42), 92.7%(38/41) and 100.0%(54/54) in indirect cold snare polypectomy, direct cold snare polypectomy and hot snare polypectomy groups, respectively. The differences among the three groups were statistically significant(all P<0.05). Conclusion The hot snare polypectomy can significantly increase the complete resection rate, but there is a risk of post-polypectomy bleeding. The risk of immediate bleeding of cold snare polypectomy is higher than hot snare polypectomy.
引文
[1] MOSS A, NALANKILLI K. Standardisation of polypectomy technique[J]. Best Pract Res Clin Gastroenterol, 2017, 31(4): 447-453.
[2] BRITTO-ARIAS M, WALDMANN E, JESCHEK P, et al. Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?[J]. Endoscopy, 2015, 47(10): 898-902.
[3] 陈桂权, 刘宇虎, 詹磊磊, 等. 冷圈套与热圈套用于结直肠小息肉切除的效果比较[J]. 广东医学, 2015, 36(23): 3665-3668.
[4] URAOKA T, RAMBERAN H, MATSUDA T, et al. Cold polypectomy techniques for diminutive polyps in the colorectum[J]. Dig Endosc, 2014, 26(Suppl 2): 98-103.
[5] FUJIYA M, TANAKA K, DOKOSHI T, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection[J]. Gastrointest Endosc, 2015, 81(3): 583-595.
[6] SUN H H, HUANG S L, BAI Y. Comment on “Efficacy and adverse events of cold vs hot polypectomy: a meta-analysis”[J]. World J Gastroenterol, 2017, 23(32): 6007-6008.
[7] SHINOZAKI S, KOBAYASHI Y, HAYASHI Y, et al. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: systematic review and meta-analysis[J]. Dig Endosc, 2018, 30(5): 592-599.
[8] ICHISE Y, HORIUCHI A, NAKAYAMA Y, et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps[J]. Digestion, 2011, 84(1): 78-81.
[9] HORIUCHI A, HOSOI K, KAJIYAMA M, et al. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps[J]. Gastrointest Endosc, 2015, 82(4): 686-692.
[10] MOSS A, BOURKE M J, METZ A J. A randomized, double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon[J]. Am J Gastroenterol, 2010, 105(11): 2375-2382.
[11] FASOULAS K, LAZARAKI G, CHATZIMAVROUDIS G, et al. Endoscopic mucosal resection of giant laterally spreading tumors with submucosal injection of hydroxyethyl starch: comparative study with normal saline solution[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3): 272-278.
[12] CHEN Y N, CHANG L C, CHANG C Y, et al. Comparison of cold and hot snaring polypectomy for small colorectal polyps: study protocol for a randomized controlled trial[J/OL]. Trials, 2018, 19(1):361. [2018-07-06]. https://doi.org/10.1186/s13063-018-2743-z.
[13] TAKAYANAGI D, NEMOTO D, ISOHATA N, et al. Histological comparison of cold versus hot snare resections of the colorectal mucosa[J]. Dis Colon Rectum, 2018, 61(8): 964-970.
[14] YAMAMOTO T, SUZUKI S, KUSANO C, et al. Histological outcomes between hot and cold snare polypectomy for small colorectal polyps[J]. Saudi J Gastroenterol, 2017, 23(4): 246-252.
[15] 刘萍, 章秀, 林慧萍, 等. 内镜下运用刻度活检钳进行息肉大小测量的临床价值[J]. 中华胃肠外科杂志, 2013, 16(12): 1142-1145.
[2] BRITTO-ARIAS M, WALDMANN E, JESCHEK P, et al. Forceps versus snare polypectomies in colorectal cancer screening: are we adhering to the guidelines?[J]. Endoscopy, 2015, 47(10): 898-902.
[3] 陈桂权, 刘宇虎, 詹磊磊, 等. 冷圈套与热圈套用于结直肠小息肉切除的效果比较[J]. 广东医学, 2015, 36(23): 3665-3668.
[4] URAOKA T, RAMBERAN H, MATSUDA T, et al. Cold polypectomy techniques for diminutive polyps in the colorectum[J]. Dig Endosc, 2014, 26(Suppl 2): 98-103.
[5] FUJIYA M, TANAKA K, DOKOSHI T, et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection[J]. Gastrointest Endosc, 2015, 81(3): 583-595.
[6] SUN H H, HUANG S L, BAI Y. Comment on “Efficacy and adverse events of cold vs hot polypectomy: a meta-analysis”[J]. World J Gastroenterol, 2017, 23(32): 6007-6008.
[7] SHINOZAKI S, KOBAYASHI Y, HAYASHI Y, et al. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: systematic review and meta-analysis[J]. Dig Endosc, 2018, 30(5): 592-599.
[8] ICHISE Y, HORIUCHI A, NAKAYAMA Y, et al. Prospective randomized comparison of cold snare polypectomy and conventional polypectomy for small colorectal polyps[J]. Digestion, 2011, 84(1): 78-81.
[9] HORIUCHI A, HOSOI K, KAJIYAMA M, et al. Prospective, randomized comparison of 2 methods of cold snare polypectomy for small colorectal polyps[J]. Gastrointest Endosc, 2015, 82(4): 686-692.
[10] MOSS A, BOURKE M J, METZ A J. A randomized, double-blind trial of succinylated gelatin submucosal injection for endoscopic resection of large sessile polyps of the colon[J]. Am J Gastroenterol, 2010, 105(11): 2375-2382.
[11] FASOULAS K, LAZARAKI G, CHATZIMAVROUDIS G, et al. Endoscopic mucosal resection of giant laterally spreading tumors with submucosal injection of hydroxyethyl starch: comparative study with normal saline solution[J]. Surg Laparosc Endosc Percutan Tech, 2012, 22(3): 272-278.
[12] CHEN Y N, CHANG L C, CHANG C Y, et al. Comparison of cold and hot snaring polypectomy for small colorectal polyps: study protocol for a randomized controlled trial[J/OL]. Trials, 2018, 19(1):361. [2018-07-06]. https://doi.org/10.1186/s13063-018-2743-z.
[13] TAKAYANAGI D, NEMOTO D, ISOHATA N, et al. Histological comparison of cold versus hot snare resections of the colorectal mucosa[J]. Dis Colon Rectum, 2018, 61(8): 964-970.
[14] YAMAMOTO T, SUZUKI S, KUSANO C, et al. Histological outcomes between hot and cold snare polypectomy for small colorectal polyps[J]. Saudi J Gastroenterol, 2017, 23(4): 246-252.
[15] 刘萍, 章秀, 林慧萍, 等. 内镜下运用刻度活检钳进行息肉大小测量的临床价值[J]. 中华胃肠外科杂志, 2013, 16(12): 1142-1145.