内镜下尼龙绳套扎联合高频电凝切除治疗结直肠息肉的疗效

Treatment of colorectal polyps by nylon iigation combined with endoscopic high-frequency electric snare

目的探讨内镜下应用尼龙绳套扎联合高频电凝切除治疗结直肠息肉的临床疗效与安全性。方法回顾性分析2006年1月至2011年1月复旦大学附属中山医院内镜下应用尼龙绳套扎联合高频电凝切除治疗345例结直肠息肉患者的临床资料。观察患者术后有无出血、穿孔等并发症发生；肠镜随访观察患者术后创面愈合及病变残留、复发情况。结果345例患者共成功切除362枚结直肠息肉。息肉直径1．5～4．0cm，平均直径2．7cm；1例患者术中出血；1例患者发生迟发性穿孔。93．6％（339／362）的息肉经病理检查证实为腺瘤性息肉，17枚为增生性息肉，5枚为炎症性息肉，l枚息肉出现癌变。334例患者术后1个月复查肠镜，9例患者残蒂存留，再次予内镜下切除，其余患者术后创面愈合良好，残蒂脱落消失。308例患者术后2个月获得肠镜检查随访，病灶均完全消失。患者首次治疗有效率为97．1％（299／308）。结论内镜下应用尼龙绳套扎联合高频电凝切除结直肠息肉安全、有效。

Objective To evaluate the clinical efficacy and safety of nylon ligation combined with endo-scopic high-frequency electric snare for the treatment of colorectal polyps. Methods The clinical data of 345 patients with colorectal polyps who received the treatment of nylon ligation combined with endoscopic high-frequency electric snare at the Zhongshan Hospital of Fudan University from January 2006 to January 2011 were retrospectively analyzed. Complications including bleeding and perforation were observed. Postoperative wound healing and local residual recurrence were assessed during follow-up. Results A total of 362 colorectal polyps were successfully removed. The mean diameter of the colorectal polyps was 2.7 cm （ range, 1.5-4.0 cm）. Operative bleeding occurred in 1 patient, and perforation in 1 patient. The results of histological examination showed that 93.6% （339/362） colorectal polyps were adenoma, 17 were hyperplastie polyps, 5 were inflammatory polyps, and eanceration of colorectal polyps in 1 patient was detected. Endoscopic follow-up was completed in 334 patients at the first month after operation, and 9 patients with residual benign colorectal polyps received endoscopic resection. No residue or recurrence was found in the other patients. Endoscopic follow-up was completed in 308 patients at the second months after operation, and no residue or recurrence was found. The overall effective rate was 97.1% （299/308）. Conclusion Endoscopic nylon ligation combined with endoscopic high-frequency electric snare is effective and safe for the treatment of colorectal polyps.