预先使用金属钛夹在内镜下高频电切消化道息肉中的作用

Effect of pre-clampping polyp pedicle with Titanium clip before endoscopic high-frequency electric knife removing polyps

目的探讨治疗消化道有蒂息肉前预先使用金属钛夹钳夹息肉蒂根部再进行内镜下高频电刀切除息肉的疗效。方法将2008年3月至2012年9月我院内镜中心行内镜下息肉高频电刀切除的168例患者,按金属钛夹使用时机的不同分为研究组(n=96)和对照组(n=72),统计分析两组在手术时间,术中、术后并发症以及钛夹使用数量上的差异。结果两组患者在胃肠道息肉构成及直径大小上差异无统计学意义(P>0.05),研究组在手术时间上要短于对照组[(19.1±7.3)min vs(30.3±9.2)min,P<0.05],在钛夹的使用数量上,当息肉蒂的直径≥2 cm时,要少于对照组[(3.11±1.09)枚vs(3.98±1.72)枚,P<0.05],当直径<2 cm时,两者差异无统计学意义[(2.01±1.01)枚vs(1.77±0.73)枚,P>0.05],术中出血研究组要少于对照组(10/96 vs 19/72,P<0.05),在术后出血及穿孔上差异无统计学意义(P>0.05)。结论术前使用金属钛夹结扎有蒂息肉根部能有效预防电凝电切时引起的出血,提高内镜高频电切除息肉的安全性。

Objective To explore the efficacy ofpre-clampping polyp pedicle with titanium clip before endo- scopic high-frequency electric knife removing polyps. Methods From March 2008 to September 2012, 168 patients with gastrointestinal polyposis had polyps removed by endoscopic high-frequency electric knife in the Endoscopy Cen- ter of Changshu First People＇s Hospital. The patients were divided into the study group （n=96） and the control group （n=72）, according to the application time of titanium clip. The information of patient＇s age, gender, the operation time, intraoperative and postoperative complications and titanium clips was recorded, and the statistical difference was ana- lyzed. Results There＇s no statistical significant difference in gastrointestinal polyp structure or diameter size （P〉 0.05）. The study group was shorter than the control group in the operation time [（19.1±7.3） min vs （30.3±9.2） min, P〈 0.05]. When polyp pedicle diameter ≥ 2 cm, the study group was less than control group in the number of titanium clamp used [（3. 11± 1.09） vs （3.98±1.72）, P〈0.05], whereas the two groups had no difference when the diameter ≤ 2 cm,[（2.01 ± 1.01） vs （1.77±0.73）, P〉0.05]. The intraoperativc biecding of the study group was less than that of the con- trol group （10/96 vs 19/72, P〈0.05）, whereas the postoperative bleeding showed no statistical difference （P〉0.05）. Conclusion Pre-clampping polyp pedicle with titanium clip before endoscopic high-frequency electric knife remov- ing polyps could prevent bleeding caused by electric coagulation and electric cutting, and improve the safety of endo- scopic high-frequency electric resection.