大肠巨大息肉的内镜治疗(附32例治疗体会)

The endoscopic treatment of large colonic polyp

目的 探讨内镜下治疗大肠巨大息肉 (直径≥2cm)的疗效及安全性 。方法 术前1天常规服用电解质溶液清洁肠道 ,手术采用结肠镜下直接分块套摘切除 (有蒂息肉 )或先用内镜注射针在息肉基底部粘膜下注射肾上腺素溶液 (1:10000) ,使局部粘膜肿胀、隆起后 ,再将息肉分块切除 (无蒂息肉 )。结果 17例有蒂息肉、5例亚蒂息肉及6例无蒂息肉摘除手术均一次性分数块切除。另有4例无蒂息肉摘除手术分2次完成 ,前后间隔2周。所有患者均无出血及穿孔等并发症发生。术后病理示管状腺瘤13例 ,绒毛状腺瘤11例 ,绒毛管状腺瘤5例 ,管状腺瘤合并早期癌2例 ,绒毛管状腺瘤合并早期癌1例。3例合并早期癌的息肉基底部均未发现癌细胞 ,故可认为得到根治。结论 内镜下治疗大肠巨大息肉简便、安全。

Objective To evaluate the efficacy and safety of endoscopic treatment of large colonic polyp (Diameter≥2cm). Method Bowel purge by electrolyte solution in the preoperative day. For pedunculated polyp, only electrocautery snare was used. But for sessile polyp, adrenaline solution(1:10000) was injected into the basilar part by endoscopic needle before electrocautery snare. Results 32 cases were cured with endoscopic therapy. The diameters of polyps were between 2.0～4.5cm. 17 peduncluated polyps,5 subpedunculated and 6 sessile polyps were removed with electrocautery resection in one time. Another 4 sessile polyps were removed in two times with an interval of two weeks. No complication occurred. Pathological found that 13 cases was tubular adenomas, 11 villous adenomas, 5 tubulovillous adenomas. Early cancers were discovered in 2 cases of tubular adenomas and in 1 case of tubulovillous adenoma, without invasion of the muscularis mucosae. Conclusion The endoscopic treatment of large colonic polyp is a simple, safe, and effective therapy.