6~10 mm肠息肉冷切除术后预防性使用金属夹的价值探讨  

Evaluation of prophylactic use of metal clips after cold resection of 6-10 mm intestinal polyps

作　　者：孙中新 吴璨 杨梅[1] 刘丽[1] 刘榴 周正奎 奚维东[1] 单晶[1] 姜琳[1] 雷雨[1] 孙晓滨[1,2] Sun Zhongxin;Wu Can;Yang Mei;Liu Li;Liu Liu;Zhou Zhengkui;Xi Weidong;Shan Jing;Jiang Lin;Lei Yu;Sun Xiaobin(Department of Gastroenterology,Chengdu Third People's Hospital,Chengdu 610031,China;Department of Gastroenterology,The Affiliated Hospital of Southwest Medical University,Chengdu 610031,China)

机构地区：[1]成都市第三人民医院消化内科,成都610031 [2]西南医科大学附属医院消化内科,成都610031

出　　处：《中华消化内镜杂志》2024年第7期550-554,共5页Chinese Journal of Digestive Endoscopy

基　　金：四川省卫生健康委员会临床研究专项(23LCYJ022)。

摘　　要：目的探讨6~10 mm肠息肉冷圈套器息肉切除术(cold snare polypectomy,CSP)后是否需要预防性使用金属夹。方法纳入2022年2月15日至2022年5月30日成都市第三人民医院内符合冷圈套器切除标准的6~10 mm息肉200例,随机分为预防性金属夹治疗组和观察组,对比分析两组间年龄、性别、体重指数(body mass index,BMI)、波士顿评分、进镜时间、创面大小、手术时间、术中出血时间、术后迟发性出血率、费用。结果金属夹治疗组98例,切除结肠息肉122枚;观察组97例,切除息肉119枚。各组间年龄、性别、BMI、波士顿评分、进镜时间、创面大小,差异无统计学意义(P>0.05)。金属夹治疗组和观察组比较,手术时间[(171.03±90.78)s比(69.81±43.26)s,t=2.266,P=0.010]、术中出血时间[(19.98±17.37)s比(29.16±17.56)s,t=-2.875,P=0.006]、手术费用[(571.63±110.92)元比(366.32±13.20)元,t=18.102,P<0.001]差异有统计学意义;2组术后迟发性出血率[0.0%(0/98)比1.0%(1/97),P=0.497],差异无统计学意义。结论针对6~10 mm肠息肉冷切除术后创面持续出血时间<60 s的患者,预防性使用金属夹虽然可减少术中出血时间,但增加了手术时间和手术费用,在预防术后并发症方面效果亦不明显。Objective To investigate whether prophylactic use of metal clips is necessary after cold snare polypectomy(CSP)of colorectal polyps of 6-10 mm.Methods A total of 200 patients with 6-10 mm polyps that met the criteria of cold snare resection in Chengdu Third People's Hospital from 15 February 2022 to 30 May 2022 were randomly divided into two groups:a group that received preventive metal clip treatment and an observation group.Age,gender,body mass index(BMI),Boston score,endoscopy entry time,wound size,operation time,intraoperative bleeding time,postoperative delayed bleeding rate and cost between the two groups were compared and analyzed.Results Ninety-eight patients in the metal clip group had 122 polyps removed,and 97 patients in the observation group had 119 polyps removed.There was no significant difference in the age,gender,BMI,Boston score,endoscopy entry time or wound size between the two groups.There were significant differences in the operation time(171.03±90.78 s VS 69.81±43.26 s,t=2.266,P=0.010),intraoperative bleeding time(19.98±17.37 s VS 29.16±17.56 s,t=-2.875,P=0.006)and surgery cost(571.63±110.92 yuan VS 366.32±13.2 yuan,t=18.102,P<0.001)between the metal clip group and the observation group.There was no significant difference in the delayed bleeding incidence[0.0%(0/98)VS 1.0%(1/97),P=0.497]between the two groups.Conclusion For patients with continuous bleeding time<60 seconds after CSP of 6-10 mm colonic polyps,the prophylactic use of metal clips may reduce the bleeding time,but may increase the operation time and cost.Metal clips have little effect on preventing postoperative complications.

关 键 词：结肠息肉 术后出血 冷圈套器息肉切除术 金属夹 

分 类 号：R656.9[医药卫生—外科学]