内镜下治疗胃肠大息肉疗效观察

Effect of endoscopic therapy on large gastrointestinal polyps

[目的]观察内镜下治疗胃肠大息肉的疗效。[方法]48例胃肠大息肉患者,息肉直径2.1～3.0cm28例,3.1～4.0cm15例,>4.0cm5例。病理组织学检查示管状腺瘤10例,绒毛状腺瘤11例,绒毛管状腺瘤17例,增生性息肉5例,息肉恶变5例。息肉有蒂者行高频电圈套切除;扁平者采取黏膜下注水后分片或分次切除。[结果]治疗成功率93.7%,8例术后即刻出血,1例术后24h出血,均予止血治疗,无一例发生穿孔。随访48例,4例息肉恶变患者随访超过3年,无复发;3例绒毛状腺瘤局部复发,2例再行局部微波或氩气刀治疗,1例建议外科手术治疗;余41例随访超过6个月,9例于其他部位发现新生息肉。[结论]内镜下治疗胃肠大息肉的方法安全、有效、可靠。

[Objective] To study the effect of endoscopic therapy on large gastrointestinal polyps. [Methods] In forty-eight patients with gastrointestinal polyps, diameter of 28 polyps was between 2. 1～3. 0 cm,15 between 3. 1～4. 0 cm,5 over 4. 0 crn. After pathologic examination,there were 10 cases of tubular adenomas, 11 villous adenomas, 17 tubulovillous adenomas, 5 hyperplastic polyps and 5 malignant polyps. Polyps with pedicel were cut with electricity polypeetomy, others with piecemeal polypeetomy after been injected water under the mueosa. [Results]The curative success rate was 93. 7%. Eight cases hemorrhaged right after operation and 1 hemorrhaged 24 hrs after operation, all of them were treated by hemostasia with no perforation. In 48 follow-ups, 4 cases with malignant polyps who had been followed over 3 years were not recurrent; 3 cases with villomas recurred in local focus, in which 2 cases were treated by microwave or argon plasma coagulation and 1 was advised to surgical therapy. Forty-one cases were followed over 6 months,in which 9 cases were found new polyps on else places. [Conclusion]Endoscopic therapy is safe, effective and credible for large gastrointestinal polyps.