糖尿病合并消化道息肉患者内镜下切除术的个体化治疗方案安全性分析

Safety of Individualized Endoscopic Resection Programs in Diabetes Patients with Gastrointestinal Polyps

目的分析糖尿病合并消化道息肉患者内镜下切除术个体化治疗方案的安全性。方法选择2007年1月—2009年5月我院收治的糖尿病合并消化道息肉患者70例,根据治疗方法分为对照组和治疗组,每组35例。对照组有蒂息肉患者采用单纯电切(9例)或单纯尼龙绳结扎(8例),扁平小息肉(9例)患者采用热活检钳治疗,广基息肉患者(9例)采用内镜下黏膜切除术(EMR);治疗组有蒂息肉(17例)、扁平小息肉(9例)、广基息肉(9例)患者分别采用尼龙绳结扎联合内镜下高频电切除术、氩等离子凝固术(APC)、尼龙绳结扎术治疗。结果对照组行单纯电切术者发生即时性出血1例,延迟性出血1例;行单纯尼龙绳结扎术者4周后内镜复查发现息肉部分残留1例,再次结扎后治疗成功;行热活检钳治疗者疗效较好,但术后腹痛较为明显;行EMR者3例创面损伤较大,采用金属夹进行闭合,术后腹痛较剧烈,4周后复查其中2例患者见金属夹残留。治疗组患者内镜下均一次性治疗成功,术中无明显不适,术后9例患者出现轻度腹胀、腹痛等不适,未出现大出血、穿孔等严重并发症;4周后复查内镜见创面均已愈合。结论内镜下切除术个体化治疗方案治疗糖尿病合并消化道息肉安全可行,应根据患者息肉特点选择创面损伤小的内镜下切除术或联合应用,糖尿病应视为消化道息肉单纯电切术的相对禁忌证。

Objective To analyze the safety of individualized endoscopic resection programs in diabetes patients with gastrointestinal polyps. Methods Seventy diabetes patients with gastrointestinal polyps were divided, according to treatment methods, into groups control and therapy, 35 in each. In control group, patients with pedunculated polyps were given electroci- sion （9 cases） or nylon rope ligation （8 cases） , those with small flat polyps （9 cases） given treatment of hot biopsy forceps, those with sessile polyps （9 cases） given endoscopic mueosal resection （EMR） ; In therapy group patients with pedunculated polyps （17 cases）, with small fiat polyps （9 cases）, with sessile polyps （9 cases） were given nylon rope ligation combined with endoscopic high - frequency electrical excision, argon ion plasma coagulation （ APC）, nylon rope ligation, respectively. Results In control group, 1 patient had immediate bleeding and 1 had delayed bleeding in patients given eleetroeision, 1 of pa- tients given nylon rope ligation had some residuals found by recheck after 4 weeks and successfully re - ligated; Patients given hot biopsy forceps treatment had good effects, but had obvious abdominal pains after operation; 3 of patients given EMR had large wound injuries and had severe abdominal pains after metal clip closure, 2 had metal clip residuals in reexamination after 4 weeks. In therapy group, all patients had one -time success without obvious discomforts. Nine patients had mild abdominal distension and pains without bleeding, perforation or other severe complications, and healed after 4 weeks. Condttsion Individualized endoscopic resection is safe and feasible in treatment of diabetes combined with gastrointestinal polyps. Endoscopic resection or its combination with small wound injuries should be chosen based on the features of polyps. Diabetes should be regarded as a contra- ry contramdwatlon for electrocision of gastrointestinal polyps.