消化道大息肉内镜下三种治疗方法疗效评价

The efficacy of three different endoscopic therapies for large gastrointestinal polyps

目的采用单纯高频电切、尼龙绳套扎联合电切与钛夹联合高频电切三种不同方法治疗消化道大息肉，观察总结其疗效结果。方法选择2009至2012年来我院治疗的消化道大息肉患者400例，将其分成A组即对照组100例，采用单纯高频电切治疗，B组即治疗组300例患者，在将B组分成B1组采用单纯尼龙绳套扎治疗，B2组采用尼龙绳套扎联合电切治疗，B3组采用先钛夹钳夹息肉根疗后加电切治＇疗．术后观察其治疗效果。结果三种方法治疗均一次性切除消化道大息肉，单纯高频电切治疗发生穿孔现象23例、出血现象18例和创面水肿、糜烂、溃疡27例，其发生例数远高于其他两种方法，差异具有统计学意义。结论尼龙绳套扎联合电切与钛夹联合高频电切切除消化道大息肉效果显著、安全、并发症较少，并且创面愈合情况较好，值得临床推广。

Objective To explore the efficacy of high-frequency electrotomy, nylon loop liga- ture combined with electrotomy, and titanium clip combined with high-frequency electrotomy in the treatment of large gastrointestinal polyps. Methods 400 patients with large gastrointestinal polys who had been hospitalized from 2009 to 2012 were divided into control group （ 100 patients, group A ） and study group （ 300 patients, group B ）, and the group B was subdivided into groups B1, 2 and 3. Group A treated with high-frequency electrotomy alone, group B1 underwent nylon loop ligature alone, group B2 received nylon loop ligature combined with electrotomy, group B3 received radical treatment with titanium clip for clipping polyps and then electrotomy. The efficacy was observed among the three groups. Results All of the three procedures could remove large gastrointestinal polyps. Nylon loop ligature combined with electrotomy and titanium clip combined with high-frequency electrotomy were obviously superior to high-frequency electrotomy alone, with less occurance of perforation and haemorrhage and better wound healing. Conclusions Nylon loop ligature combined with electrotomy and titanium clip combined with high-frequency electrotomy for removal of large gastrointestinal polyps are efficacious and safe and have better wound healing and fewer complications. They are worth popularizing clinically.