儿童结肠息肉内镜特点、治疗及病理探讨  

Endoscopic examination and pathology of colonic polyps in children

作　　者：蒋丽蓉[1] 周莎[1] 张斌[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心,上海200127

出　　处：《临床儿科杂志》2010年第3期247-250,共4页Journal of Clinical Pediatrics

摘　　要：目的对儿童结肠息肉的内镜、病理特点及内镜治疗进行探讨总结。方法收集2002年11月至2009年9月肠镜检出并肠镜下切除的儿童结肠息肉121例临床资料,患儿采用Olympus PCF240I电子肠镜行全结肠检查,Olympus UES-30高频电凝电切摘除结肠息肉治疗。结果121例结肠息肉患儿皆因便血就诊,部分伴有黏液便,病程1周～8年。其中单发息肉94例(77.7%),2枚息肉6例(5.0%),多发性息肉21例(17.3%)。其中结肠息肉病5例,息肉直径0.3～4cm,形态山田Ⅰ型～Ⅳ型,病理为幼年性息肉、炎性息肉、息肉样形成和管状腺瘤。121例以山田Ⅳ型、幼年性息肉为主,其中结肠息肉中幼年性息肉共107例(占88.4%)。5例结肠息肉病中发现1例息肉恶变。115例在全身麻醉下行内镜高频电凝、电切治疗,无1例发生严重并发症。结论结肠息肉是儿童较常见的疾病之一。儿童中若出现便血、贫血或直肠息肉脱垂、肠套叠等表现时,应及时进行全结肠镜检查。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,需定期结肠镜复查,或有便血应随时复查。结肠息肉病者在内镜下切除有困难时,建议行外科手术切除。Objective To retrospectively study the results of endoscopic manifestation pathology,and treatment of colonic polyps.Methods Clinical data of 121 patients diagnosed with colonic polyps and treated by endoscopy between November 2002 and September 2009 were studied.Complete colonic investigation was done by Olympus PCF240I electron endoscopy.Colonic polyp excision was done by high frequency electric coagulation.Results All patients had bloody stool with mucus for 1 week to 8 years.Ninty-four （77.7%） patients had a single polyp,6 （5.0%） had two polyps,21 （17.3%） with multiple polyps,and 5 patients had familial polyposis coli.The size of the polyps ranged from 0.3 cm to 4 cm and the morphology of Yamada Ⅰ to Ⅳ.The pathological changes were juvenile polyps,inflammatory polyps,polypoid formation,and canalicular adenoma.Most common pathology types were Yamada Ⅳ and juvenile polyps,107 of the 121 patients （ 88.4% ） had juvenile polyps,and one was found to have malignant transformation.115 patients accepted high frequency electric coagulation excision under general anesthesia,without complication.Conclusions Colonic polyp is one of the common diseases in children.Children should be checked by total colonoscopy in time when they present with bloody stool,anemia,rectal polyps prolapse or intussusception.Polypectomy under endoscope is a most safe and reliable treatment method when the diagnosis is confirmed.For isolated juvenile polyp,regular recheck is not necessary after polypectomy except when bloody stool recurs.Regular follow up by colonoscope is necessary for juvenile polyp combined with adenoma and adenomatous polyps.Colonoscope is necessary at any time when bloody stool occurs.Familial polyposis coli is difficult to be treated by endoscopy,thus surgical procedure is suggested.

关 键 词：儿童 息肉 病理 内镜 

分 类 号：R726.5[医药卫生—儿科]