青海地区结直肠小息肉内镜下冷切割疗效临床研究  

A clinical study on endoscopic cold polypectomy for small colorectal polyps in Qinghai area

作　　者：薛晓红[1] 刘芝兰[1] 李晓林 白菊芳 逯艳艳[1] 丹珠永吉[1] 马颖才[1] Xue Xiaohong;Liu Zhilan;Li Xiaolin;Bai Jufang;Lu Yanyan;Yongji Danzhu;Ma Yingcai(Department of Gastroenterology,Qinghai Provincial People's Hospital,Xining 810007,China)

机构地区：[1]青海省人民医院消化内科,西宁810007

出　　处：《中华消化内镜杂志》2024年第6期455-458,共4页Chinese Journal of Digestive Endoscopy

基　　金：青海省卫生健康委员会指导性计划课题(2020-wjzdx-34)。

摘　　要：目的探讨结直肠小息肉应用冷切割,以及预防性使用止血夹治疗的安全性及有效性。方法选择2021年1月至2022年3月青海省人民医院符合纳排标准的260例结肠小息肉患者,分层随机分为冷圈套切除术(cold snare polypectomy,CSP)治疗的CSP组、CSP+预防性使用止血夹治疗的CSP+止血夹组、热圈套切除术(hot snare polypectomy,HSP)治疗的HSP组及HSP+预防性使用止血夹治疗的HSP+止血夹组,每组各65例。比较治疗情况、出血发生率及其他并发症发生率。结果患者基本特征和息肉病变特征4组间差异无统计学意义(P>0.05)。4组出现的并发症,术中即时出血发生率[5例(7.69%)、4例(6.15%)、3例(4.62%)、3例(4.62%)],以及术后迟发性出血发生率[0例(0.00%)、0例(0.00%)、1例(1.54%)、0例(0.00%)],4组间差异均无统计学意义(χ^(2)=0.778,P=0.855;χ^(2)=3.012,P=0.390);术后腹痛发生率,HSP组[7例(10.77%)]最高,与CSP组[1例(1.54%)]及CSP+止血夹组[1例(1.54%)]相比差异有统计学意义(P<0.05)。单个息肉治疗时间,CSP组最短[(2.18±1.07)min],HSP组次之[(2.83±0.82)min],CSP组+止血夹组再次之[(3.15±1.16)min],HSP组+止血夹组用时最长[(4.88±1.85)min],4组间差异有统计学意义(F=50.397,P<0.001)。结论推荐使用冷切割治疗结直肠小息肉,如术中判断无出血及穿孔风险,无须预防性使用止血夹。Objective To investigate the safety and effectiveness of endoscopic cold snare resection of small colorectal polyps and prophylactic hemostatic clip.Methods A total of 260 patients diagnosed as having small colorectal polyps in Qinghai Provincial People's Hospital from January 2021 to March 2022 were randomly assigned to cold snare polypectomy(CSP)group(receiving CSP),CSP+hemostatic clip group(receiving CSP+prophylactic hemostatic clip),hot snare polypectomy(HSP)group,and HSP+hemostatic clip group(receiving HSP+prophylactic hemostatic clip).Each group had 65 cases.The treatment,incidence of bleeding,and other complications were compared.Results There was no significant difference in the basic characteristics of patients or polyps among the four groups(P>0.05).Immediate intraoperative bleeding occurred in 5 cases(7.69%),4 cases(6.15%),3 cases(4.62%),and 3 cases(4.62%)in the four groups respectively with no significant difference(χ^(2)=0.778,P=0.855),while only 1 delayed postoperative bleeding was observed in HSP group with no significant difference among the four groups(χ^(2)=3.012,P=0.390).The incidence of postoperative abdominal pain was the highest in the HSP group(n=7,10.77%)significantly different from those of the CSP group(n=1,1.54%)and the CSP+hemostatic clip group(n=1,1.54%)(P<0.05).Polypectomy time of single polyp in CSP group was the shortest(2.18±1.07 min),followed by HSP group(2.83±0.82 min),then CSP+hemostatic clip group(3.15±1.16 min),with HSP+hemostatic clip group(4.88±1.85 min)being the longest(F=50.397,P<0.001).Conclusion It is suggested to use CSP for small colorectal polyps.If there is no risk of bleeding or perforation during the operation,it is not necessary to use prophylactic hemostatic clips.

关 键 词：肠息肉 切除边缘 止血技术 圈套息肉切除术 

分 类 号：R735.34[医药卫生—肿瘤]