结肠巨大息肉内镜下治疗安全性的探讨

Safety of Endoscopic Resection of Large Colonic Polyps

【目的】介绍内镜下治疗结肠巨大息肉（〉2．5cm）的经验，探讨其安全性及并发症的防治。【方法】常规做肠道准备，采用电子肠镜下直视操作，应用圈套器直接套扎或分块套扎带蒂和亚蒂巨大息肉；应用针形电切刀，切割巨大息肉基底部或无蒂息肉表面；应用内镜注射针，在无蒂息肉基底部黏膜下注射肾上腺素盐水，使局部黏膜肿胀、隆起，再分块切除。并与普通息肉组比较，两者的疗效及并发症。【结果】462例结肠巨大息肉患者，共968枚息肉，均成功切除。与普通息肉组相比较，两组一次性切除与二次性切除及分块切除息肉数有显著性差异（P〈0．01）；两组并发症比较（出血、肠壁电凝损伤、肠道感染）有显著性差异（P〈0．01）。【结论】内镜下高频电切术治疗结肠巨大息与普通组比较并发症多，风险大，但术前充分准备、严格掌握适应证，术中耐心细致操作，术后严密观察，结肠巨大息肉电凝术是安全，可靠的。

[Objective]To introduce the method of endoscopic resection of large colonic polyps and to evaluate its safety. [Methods] Colon preparation was made by routine method. For the large pedunculated polyps or sub-pedunculated polyps, completely resection of the polyps was made with eleetrocautery snare using direct or partial resection method according to the polyps＂ size. For the sessile polyps, adrenaline salt solution was injected into the submucosa of basilar part through endoscopic needle, and then the entire elevated polyps were excised. [Results]All 968 large colonic polyps in 462 patients were cured successfully. There was significantly different in the number of excised polyps between large colonic polyp groul6 and common polyp group （ P〈 0.01）. There was significantly different in the complications （bleeding, intestinal wall electric injury, intestinal infection, etc. ） between large colonic polyp group and common polyp group （ P〉 0.05）. [Conclusion] Endoscopic high frequency electrical resection for large colonic polyps has more complications and high risks. But it will be a safe and reliable method if full preparation before operation is done, and the indications are known, and the manipulation in the operation is patient and careful.