冷圈套切除较大结直肠息肉的临床研究  

A clinical study of cold snare resection for large colorectal polypS

作　　者：陈琳[1] 赵晶[1] 金海峰[1] 黄亮[1] 金波[1] 毛立祺 吕宾[1] Chen Lin;Zhao Jing;Jin Haifeng;Huang Liang;Jin Bo;Mao Liqi;Lyu Bin(Department of Gastroenterology,The First Affiliated Hospital of Zhejiang Chinese Medical University,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学附属第一医院消化科,杭州310006

出　　处：《中华消化内镜杂志》2021年第10期823-827,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜下采用冷圈套息肉切除术(cold snare polypectomy, CSP)与热圈套息肉切除术(hot snare polypectomy, HSP)治疗10~15 mm结直肠息肉的有效性及安全性。方法采集2019年12月—2020年12月间接受结肠镜检查、发现至少1枚10~15 mm息肉、并行结肠镜下切除患者资料154例, 息肉173枚, 形态表现为巴黎分型Ⅰsp、Ⅰs或Ⅱa。按随机数字表法将息肉随机分成CSP组(息肉85枚)和HSP组(息肉88枚)。比较两组手术方式在息肉大小、位置、形态、组织学分类、完全切除率、并发症发生率、切除时间、金属夹使用数量等方面的情况。结果两组患者在年龄、性别、肠镜指征、回肠末端插管成功率方面差异无统计学意义。两组息肉在大小、位置、形态、组织学分类上具有可比性。CSP组在息肉完全切除率、术中出血率、术后延迟出血、穿孔等方面与HSP组比较, 差异亦无统计学意义。但CSP组手术时间明显短于HSP组[(63.5±23.6)s比(184.3±62.4)s, P<0.05], 使用金属夹亦明显少于HSP组[(0.8±0.5)枚比(1.4±0.7)枚, P<0.05], 差异有统计学意义。结论 CSP与HSP在切除10~15 mm结直肠无蒂息肉上有相似的完全切除率和并发症发生率, 但CSP手术时间更短, 金属夹使用数量更少。Objective To investigate the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP)for the removal of colorectal polyps of 10-15 mm.Methods A total of 173 polyps of 154 patients with at least one polyp of 10-15 mm were resected under colonoscopy from December 2019 to December 2020.Based on Paris classification,the polyps were divided intoⅠsp,Ⅰs andⅡa.According to random number table,the polyps were randomly divided into CSP group(n=85)and HSP group(n=88).The polyp size,location,morphology,histological classification,complete resection rate,incidence of complications,resection time and the number of prophylactic clips were compared between the two groups.Results There were no significant differences in age,sex,indication of colonoscopy or the success rate of intubation at the end of ileum between the two groups.The polyps of the two groups were comparable in size,position,morphology and histological classification.There were no significant differences in the complete resection rate of polyps,rates of intraoperative bleeding and postoperative bleeding or perforation between the CSP group and the HSP group.The operation time in CSP group was significantly shorter than that in HSP group(63.5±23.6 s VS 184.3±62.4 s,P<0.05).The number of prophylactic clips used in CSP group was significantly less than that in HSP group(0.8±0.5 VS 1.4±0.7,P<0.05).Conclusion CSP shows similar complete resection rate and complication incidence,and requires shorter operation time and fewer prophylactic clips,compared with HSP,in the resection of colorectal sessile polyps of 10-15 mm.

关 键 词：肠息肉 手术后并发症 冷圈套息肉切除术 热圈套息肉切除术 完全切除率 

分 类 号：R657.1[医药卫生—外科学]