结肠巨大息肉内镜黏膜切除术术中出血1例

A case of hemorrhage after endoscopic mucosal resection of a large colonic polyp

结直肠巨大息肉(直径>2.0 cm)癌变几率较高,内镜下微创切除是首选治疗,但有并发出血风险.本文报告1例56岁男性患者,降乙结肠交界处巨大带蒂息肉(3.0 cm×3.5cm),行内镜黏膜切除术(endoscopic mucosal resection,EMR)切除息肉后,创面持续渗血,氩离子凝固术(argon plasma coagulation,APC)处理后,创面搏动性出血,电凝止血钳钳夹亦难以止血.以钛夹封闭创面,创面下方迅速形成血肿,后送外科急诊手术切除病变肠段.对类似病例,应尽可能利用尼龙圈套扎,术中充分电凝,较大创面尽早使用钛夹止血和封闭.

Large colonic polyps（with a diameter larger than 2 cm） are associated with an increased risk of malignancy.Endoscopic resection is the first line treatment;however,there is a risk of bleeding.We reported a 56-year-old man with a large pedunculated polyp（3.0 cm × 3.5 cm）located between the rectum and the sigmoid.After endoscopic mucosal resection,the patient suffered from continuous hemorrhage at the wound site.He was then treated by argon plasma coagulation（APC）,bipolar coagulation and hemoclip hemostasis.Unfortunately,all these attempts ended in failure.Finally,an operation was performed and a segment of the colon was removed to save his life.From this case we can learn that we should use endoscopic nylon loop as much as possible when treating large pedunculated polyps.In addition,we should do our best to stop the bleeding at the same time.