内镜下治疗246例大肠有蒂大息肉的临床分析

Clinical analysis of 246 cases of large colorectal edunculated polyps treated under endoscopy

摘要:

目的 探讨如何选择大肠有蒂大息肉圈套电切除方式。方法 回顾性分析2016年1月－2020年1月246例（259枚息肉）在厦门市中医院行大肠有蒂大息肉（直径≥1.0 cm）圈套电切除治疗患者的内镜和病理资料，统计内镜下黏膜切除术（EMR）组、钛夹组和尼龙绳组内镜下治疗操作成功率、息肉整块切除率、完整切除率、治愈性切除率和并发症发生率。结果 有蒂大息肉中，腺瘤性息肉形态改变86.89%（179/206）高于非腺瘤性息肉的28.30%（15/53）（P < 0.01）。尼龙绳组息肉直径最大（2.13±0.70）cm，钛夹组（1.51±0.44）cm，EMR组最小（1.31±0.31）cm，3组比较，差异有统计学意义（P < 0.05）。尼龙绳组癌变率为46.15%（24/52），高于EMR组的17.24%（25/145）（P < 0.01）。圈套电切除息肉完整切除率、整块切除率均为100.00%，治愈性切除率为98.46%（255/259），出血率为7.34%（19/259），穿孔率为0.00%（0/259）。EMR组操作成功率和治愈性切除率均为100.00%（145/145），钛夹组分别为98.39%（61/62）和100.00%（62/62），尼龙绳组均为92.31%（48/52）。EMR组出血率、术中出血率和术后出血率分别为10.34%（15/145）、8.97%（13/145）和2.07%（3/145），钛夹组分别为1.61%（1/62）、0.00%（0/62）和1.61%（1/62），尼龙绳组分别为5.77%（3/52）、3.85%（2/52）和1.92%（1/52），钛夹/尼龙绳预防性蒂部结扎分别为3.51%（4/114）、1.75%（2/114）和1.75%（2/114）。结论 ≥ 1.0 cm的有蒂息肉直径越大、癌变率越高。临床上可根据息肉直径不同采用EMR法、钛夹或尼龙绳法，钛夹/尼龙绳预防性蒂部结扎对预防出血有一定的作用。

Abstract:

Objective To explore the choice of endoscopic resection of large colorectal pedunculated polyps.Methods Clinical and pathological data of 246 patients (259 lesions) with large pedunculated colorectal polyps (diameter≥1.0 cm), were retrospectively analyzed from January 2016 to January 2020. The rate of successful treatment, of whole polyp resection, of complete resection, and the rate of the curative resection, of incidence complications were analyzed.Results Adenomatous polyps morphological changes (86.89%, 179/206) was higher than non adenomatous polyps (28.30%, 15/53) (P < 0.01). Polyp diameter of nylon rope group was the largest (2.13 ± 0.70) cm, followed by titanium clip group (1.51 ± 0.44) cm, EMR group was the smallest (1.31 ± 0.31) cm, the difference among the three groups was statistically significant (P < 0.05). The rate of canceration in nylon rope group was 46.15% (24/52) higher than that in EMR group 17.24% (25/145) (P < 0.01). The complete resection rate and whole resection rate were 100.00%, the rate of curative resection was 98.46% (255/259), bleeding was 7.34% (19/259), perforation was 0.00% (0/259). The rate of success and curative resection were 100.00% (145/145) in EMR group, 98.39% (61/62) and 100.00% (62/62) in titanium clip group, 92.31% (48/52) in nylon rope group respectively. The bleeding rate, intraoperative and postoperative bleeding rate of EMR group were 10.34% (15/145), 8.97% (13/145) and 2.07% (3/145), titanium clip group were 1.61% (1/62), 0.00% (0/62) and 1.61% (1/62), nylon rope group were 5.77% (3/52), 3.85% (2/52), and 1.92% (1/52), preventive pedicle ligation with titanium clip/nylon rope were 3.51% (4/114), 1.75% (2/114) and 1.75% (2/114).Conclusion The larger the diameter of pedicle polyps ≥ 1.0 cm, the higher the rate of canceration. EMR, titanium clip or nylon rope can be used according to different polyp diameter. There had a certain effects to prevent bleeding complication by nylon rope and titanium clip assistance.