内镜下套扎加电切治疗大肠粗大息肉136例病理及疗效观察  

Observation on 136 cases' pathology and efficacy of endoscopic nylon snare loop ligature combined with electroexcision for colorectal large polyps

作　　者：侯俊[1] 邱磊[1] 江浩[1] 李静娴[1] 马俊[1] 

机构地区：[1]广东省佛山市第二人民医院,广东佛山528000

出　　处：《中国内镜杂志》2011年第7期683-686,共4页China Journal of Endoscopy

摘　　要：目的探讨大肠粗大息肉的大小、病理类型与息肉癌变关系及内镜下尼龙绳套扎联合电切的内镜治疗效果。方法内镜下对直径1.6～3.0cm的粗大息肉,于蒂部尼龙圈套扎后行高频电息肉切除。切除息肉按大小分组病理检查。息肉非局灶性恶变者进一步行手术根治,并定期肠镜追踪观察。结果 136例共158粒粗大息肉行套扎后电切除治疗,病理检查发现息肉癌变37粒,癌变率23.4%,息肉直径1.6～2.0cm93粒发现癌变17粒,癌变率18.3%。息肉直径2.1～2.6cm43粒癌变11粒,癌变率25.6%。息肉直径2.6～3.0cm22粒癌变9粒,癌变率40.9%。管状腺瘤息肉64粒,癌变15粒,癌变率44.4%,管状绒毛状腺瘤息肉47粒,癌变13粒,癌变率27.7%,绒毛状腺瘤息肉26粒,癌变9粒,癌变率34.6%。病理发现局灶癌变原位癌19例,占癌变息肉51.2%。非局灶癌变的早期大肠癌16例,占癌变息肉43.2%,均行根治手术,其中6粒(37.5%)术中发现息肉生长蒂部肠壁癌细胞浸润,2粒(1.3%)癌变息肉肠段近旁发现淋巴结转移。息肉切除患者无出血、穿孔并发症出现,定期肠镜未见异常。结论大肠粗大息肉直径越大越易恶变,腺瘤性息肉是癌变的高危因素。采用内镜下尼龙绳套扎后电切除完整息肉组织,并病理检查能提高癌变息肉的诊断治疗,并发症少。[Objective] To evaluate the relationship between the size,pathological type and canceration of colorectal large polyps;To observe therapeutic effects of endoscopic nylon snare loop ligature combine with electroexcision.[Methods] The large polyps whose diameters are between 1.6~3.0cm were under electrosurgical excision after nylon snare loop ligature at the stalk.The removed polyps were conducted biopsy according to their size.Those patients who had non-focal malignant polyps took further surgical therapy and would be followed by colonoscopy periodically.[Results] 136 cases with 158 large polyps had been under polypectomy through nylon snare loop ligature combined with electroexcision,pathologically,35 polyps developed cancer,the cancer rate was 22.2%;17 polyps developed cancer among 93 polyps whose diameters were 1.6~2.0 cm,the cancer rate was 18.3%;11 polyps developed cancer among 43 polyps with whose diameters were 2.1~2.6 cm,the cancer rate was 25.6%;8 polyps developed cancer among 22 polyps with which diameters were 2.6~3.0 cm,the cancer rate was 36.4%.There were 64 tubular adenoma polyps with 14 cancerations,the cancer rate is 21.9%;there are 47 tubular villous adenoma polyps with 13 cancerations,the cancer rate is 27.7%;there were 26 villous polyps with 9 cancerations,the cancer rate was 34.6%.Through the pathological finding,there were 19 cases with focal carcinoma in situ,which share 54.3% of cancerous polyps.While there were 16 cases in early colorectal cancer with non-focal carcinoma,which share 45.7% of cancerous polyps,and had radical surgery,surgery found that 6 polyps（37.5%） with cancer cell infiltration in the pedicle,2 polyps（1.3%） with lymph node metastasis near cancerous bowel polyps.The patients who had received polypectomy didn＇t present complications like hemorrhage and perforation,and regular colonoscopy was normal.[Conclusions] Colorectal large polyps have higher ratio of canceration,the larger the diameter is,the easier the malignant will be,adenomatous polyp is the high risk fac

关 键 词：尼龙圈套扎 高频电切除 大肠息肉 息肉癌变 

分 类 号：R574.6[医药卫生—消化系统]