儿童结直肠息肉的内镜治疗
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摘要
儿童结直肠息肉是临床中无痛性便血、腹痛和肛门肿物突出最主要的就诊原因。根据临床表现和组织学结构上的差异分类,早期诊治不影响生长发育及营养吸收。发现息肉应行内镜下息肉切除,若幼年性息肉合并腺瘤或为腺瘤性息肉,需定期行结肠镜复查。目前内镜下高频电凝电切术联合金属钛夹是治疗儿童结直肠息肉的主要方法之一。
Hematochezia,abdominal pain and anal tumor are the main clinical complaints of colonic polyps in children.Classification is made according to clinical manifestation and histological structure difference,and growth and development and nutrient absorption are not affected by early diagnosis and treatment. Polyps should be removed by endoscopic polypectomy,if juvenile polyps are combined with adenoma or adenomatous polyp,regular colonoscopy should be done. At present,endoscopic high-frequency electrocoagulation combined with metal titanium clip is one of the main methods for the treatment of colorectal polyps in children.
Hematochezia,abdominal pain and anal tumor are the main clinical complaints of colonic polyps in children.Classification is made according to clinical manifestation and histological structure difference,and growth and development and nutrient absorption are not affected by early diagnosis and treatment. Polyps should be removed by endoscopic polypectomy,if juvenile polyps are combined with adenoma or adenomatous polyp,regular colonoscopy should be done. At present,endoscopic high-frequency electrocoagulation combined with metal titanium clip is one of the main methods for the treatment of colorectal polyps in children.
引文
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[26]桑建忠,张红,周建波,等.结肠息肉内镜下切除术后迟发性出血的危险因素[J].中华消化杂志,2017,37(12):835-838.
[27]王洋,金忠芹,武庆斌.儿童结肠息肉临床诊治分析[J].临床儿科杂志,2017,35(11):860-863.
[2]Vyas M,Yang X,Zhang X.Gastric hamartomatous polyps-review and update[J].Clin Med Insights Gastroenterol,2016,9(9):3-10.
[3]Lowichik A,Jackson WD,Coffin CM.Gastrointestinal polypesis in childhood:Clinjcopathologic and genetic features[J].Pediatr Dev Pathol,2003,6(5):371-391.
[4]刘璐,王大勇,陈巍,等.儿童结肠息肉590例诊治分析[J].临床小儿外科杂志,2015,14(4):298-301.
[5]Brosens LA,Wood LD,Offerhaus GJ,et al.Pathology and genetics of syndromic gastric polyps[J].Int J Surg Pathol,2016,24(3):185-199.
[6]Jass JR,Williams CB,Bussey HJ,et al.Juvenile polyposis:Aprecancerous condition[J].Histopathology,1988,13(6):619-630.
[7]Elitsur Y,Teitelbaum JE,Rewalt M,et al.Clinical and endoscopic data in juvenile polyposis syndrome in preadolescent children:A multicenter experience from the United States[J].JClin Gastreenterol,2009,43(8):734-736.
[8]Soer E,de Vos Tot Nederveen Cappel WH,ligtenberg MJ,et al.Massive gastric polyposis associated with a germline SMAD4gene mutation[J].Fam Cancer,2015,14(4):569-573.
[9]Shaco-Levy R,Jasperson KW,Martin K,et al.Morphologic characterization of hamartomatous gastrointestinal polyps in Cowden syndrome,Peutz-Jeghers syndrome,and juvenile polyposis syndrome[J].Hum pathol,2016,49:39-48.
[10]Blatter RH,Plasilova M,Wenzel F,et al.Somatic alterations in juvenile polyps from BMPR1A and SMAD4 mutation carriers[J].Gen Chrom Can,2015,54(9):575-582.
[11]林彦锋,杨霞.Peutz-Jeghers综合征研究进展[J].胃肠病学和肝病学杂志,2018,27(1):96-99.
[12]樊祥山,于成功,黄勤.Peutz-Jeghers综合征研究进展[J].中华消化内镜杂志,2012,29(2):118-120.
[13]黄蕾,朱明,马国建,等.Peutz-Jeghers综合征家系的临床特征并LKB1/STK11基因突变分析[J].中华生物医学工程杂志,2016,22(4):293-297.
[14]Huang Z,Miao S,Wang L,et al.Clinical characteristics and STK11 gene mutations in Chinese children with Peutz-Jeghers syndrome[J].BMC Gastroenterol,2015,15(1):166.
[15]Dumo CA.Colonic polyps in children and adolescents[J].Can J Gastroenterol,2007,21(4):233-239.
[16]Baranrd J.Screening and surveillance recommendations for pediatric gastrointestinal polyposis syndromes[J].J Pediatr Gastroenterol Nutr,2009,48(Suppl 2):75-78.
[17]Claes K,Dahan K,Tejpar S,et al.The genetics of familial adenomatous polyposis(FAP)and MUTYH-associated polyposis(MAP)[J].Acta Gastroenterol Belg,2011,74(3):421-426.
[18]Winawer SJ.Screening of colorectal PMEnleer[J].Surg Oncol Clin N Am,2005,14:699-722.
[19]Froehlich F.Is cold biopsy forceps resection of diminutive polyps really so inadequate?[J].Endoscopy,2011,43(11):1015.
[20]段志英,王鹏羽,韩双双,等.冷圈套治疗结直肠小息肉应用价值的Meta分析[J].中华消化内镜杂志,2015,32(12):832-836.
[21]孙永刚,杨小毛,杜选峰,等.内镜下黏膜切除术治疗胃肠道息肉样病变的70例临床分析[J].胃肠病学和肝病学杂志,2013,22(12):1216-1217.
[22]Agnifili A,Schietroma M,Mattucci S,et al.Clinical assessment of juvenile polyposis with particular reference to the risk of neoplastic malignancy:analysis of 412 patients reported in the international literature[J].Chir Ital,2000,52(4):393-404.
[23]Ferrara F,Luigiano C,Ghersi S,et al.Efficacy,safety and outcomes of"inject and cut"endoscopic mucosal resection for large sessile and flat colorectal polyps[J].Digestion,2010,82(4):213-220.
[24]Gostout CJ,Knipshield MA.Submucosal endoscopy with mucosal resection:a hybrid endoscopic submucosal dissection in the porcine rectum and distal colon[J].Gastrointest Endoscopy,2012,76(4):829-834.
[25]何梦江,钟芸诗,姚礼庆.结肠息肉氩离子凝固术后迟发性穿孔一例[J].中华消化内镜杂志,2012,29(9):531-532.
[26]桑建忠,张红,周建波,等.结肠息肉内镜下切除术后迟发性出血的危险因素[J].中华消化杂志,2017,37(12):835-838.
[27]王洋,金忠芹,武庆斌.儿童结肠息肉临床诊治分析[J].临床儿科杂志,2017,35(11):860-863.