冷圈套切除术治疗 ≤ 1.0 cm结直肠息肉的有效性和安全性

Effectiveness and safety of cold snare polypectomy for colorectal polyps ≤ 1.0 cm

摘要:

目的 探讨冷圈套切除术（CSP）与热圈套切除术（HSP）治疗直径 ≤ 1.0 cm结直肠息肉的有效性和安全性。方法 选取2018年6月－2020年3月南京医科大学附属淮安第一医院因结直肠息肉（直径 ≤ 1.0 cm）行内镜下切除治疗的1 403例患者作为研究对象，分为CSP组（n = 213）和HSP组（n = 1 190），比较两组钛夹使用、出血穿孔发生率、术后内镜下止血率和组织学完整切除率等。结果 HSP组术后迟发性出血发生率明显高于CSP组（4.9%和0.9%，P = 0.003）。HSP组有5例发生术后迟发性穿孔，而CSP组无1例。CSP组息肉组织完整切除率为95.8%（204/213），与HSP组的97.6%（1 162/1 190）比较，差异无统计学意义。结论 CSP治疗直径 ≤ 1.0 cm的结直肠息肉术后出血风险低，钛夹使用数少，术后内镜下止血率低，而组织学完整切除率与HSP接近，是一种安全、有效的治疗方式。

Abstract:

Objective To compare and investigate the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP) for colorectal polyps with diameters ≤ 1.0 cm.Methods 1 403 patients with colorectal polyps ( ≤ 1.0 cm) treated in the Affiliated Huai’an No.1 People's Hospital of Nanjing Medical University from June 2018 to March 2020 were selected as research subjects. They were divided into CSP group (n = 213) and HSP group (n = 1 190). The hemoclip applications, the rates of hemorrhage and perforation, the hematischesis rates after polypectomy and the complete resection rate were compared between the two groups.Results The delayed hemorrhage rate of HSP group was significantly higher than that in CSP group (4.9% vs 0.9%, P = 0.003). There were 5 cases of delayed perforation in HSP group, no one in CSP group. The complete resection rate in CSP group was 95.8% (204/213) similar to 97.6% (1 162/1 190) in HSP group.Conclusion CSP is safe and effective in treatment of colorectal polyps ( ≤ 1.0 cm). CSP retains the low risks of delayed bleeding, less hemoclip applications and the low rates of endoscopic hemostasis, has a high complete resection rate compared to HSP.