内镜下高频电切术治疗不同类型大肠息肉 的安全性及可行性分析

Safety and feasibility analysis of endoscopic high-frequency electroresection treating different types of colorectal polyps

摘要:

目的 探讨不同类型大肠息肉临床特点及应用高频电切术治疗的临床效果。方法 回顾性分析该院2005年1月~2008年12月在门诊行肠镜检查的3 896例患者的临床资料，其中肠镜检查发现大肠息肉患者378例，患者均接受高频电切手术治疗。结果 378例患者中腺瘤性息肉158例（14.21％），炎性息肉132例（34.11％），增生性息肉55例（14.21％），幼年性息肉33例（8.53％）。大肠息肉主要生长在直肠及乙状结肠位置，与盲肠、横结肠及升结肠发生率相比，差异有显著性（P <0.05）。不同类型息肉患者手术时间、术中出血、术后排气、术后离院时间差异无显著性（P >0.05）。4种类型息肉1次性治愈率及术后并发症差异无显著性（P >0.05），但腺瘤性息肉术后1、3及5年内复发率显著高于其他3种类型（P <0.05）。结论 高频电切术对不同类型大肠息肉均具有较好的治疗效果，对于30～60岁直肠或乙状结肠息肉患者属需加强随访，并及时采用相应的治疗措施。

Abstract:

【Objective】 To investigate the clinical characteristics of different types of colorectal polyps and the clinical results of high-frequency electric resection. 【Methods】 The clinical data of 33896 cases of patients of outpatient colonoscopy were retrospected from January 2005 to December 2008. 378 cases were found the colorectal polyps. The patients of colorectal polyps were treated with high-frequency electrosurgical excision. 【Results】 There were 158 cases (14.21%) of patients with adenomatous polyps, 132 cases (34.11%) of inflammatory polyps,55 cases (14.21%) of hyperplastic polyps, 33 cases (8.53%) of juvenile polyps. Colorectal polyps in the rectum and sigmoid colon major growth position,compared with the cecum, ascending colon, transverse colon and the incidence difference was statistically significant(P <0.05). Different types of polyps in patients with operative time,blood loss, postoperative discharge, no significant difference (P >0.05). 4 types of polyps one-time cure rate and postoperative complications were no significant difference (P >0.05), but adenomatous polyps patients with high-frequency electroresection after 1 year, 3 years, 5 years, the recurrence rate was significantly higher than the other three types (P <0.05). 【Conclusion】 High frequency electrosurgical excision procedure for different types of colorectal polyps have high therapeutic effect, postoperative recurrence rate of complications is low, safe and reliable, without affecting the colon polyp type. 30 to 60 years old rectum or sigmoid polyps are of high risk, high rate of recurrence in patientswith adenomatous polyps, and therefore these patients should be strengthened postoperative follow-up, in order to promptly adopt appropriate therapeutic measures.