结肠镜反转下氩离子凝固术接触式治疗超低位直肠息肉的临床价值

Applying contact-mode argon plasma coagulation for retroflex colonoscopic treatment of ultra-lower rectal polyps

目的观察结肠镜反转法接触式应用氩离子凝固术(APC)治疗超低位直肠息肉的临床价值。方法对17例经结肠镜直镜下治疗失败的46枚小于1.0 cm广基扁平的超低位直肠息肉患者采用结肠镜U形反转法接触式应用APC进行治疗。观察探头接触和治疗靶息肉的成功率、探头与凝固组织粘连及被堵塞的发生率、黏膜下气肿的发生率,以及肠镜镜身灼伤的发生率。结果对上述17例患者行结肠镜反转法探头均能接触到靶息肉。每例患者的息肉均在1次肠镜下行APC成功灼除。所有46枚靶息肉被灼除所需喷凝次数共97次。其中仅5次(5.15%)探头与息肉凝固组织有少许粘连,分离时未出现因粘连对凝固面的损伤;仅2次(2.06%)发生因凝固组织黏着致氩气管堵塞,将黏着物清除后恢复正常使用。未发生黏膜下气肿。无1例次发生肠镜镜身灼伤。结论结肠镜反转下接触式应用APC治疗超低位直肠息肉的方法,安全有效,能预防氩气刀对肠镜镜身的损伤。

Objective To explore the clinical values of applying contact-mode argon plasma coagulation（APC） for retroflex colonoscopic treatment of ultra-lower rectal polyps. Methods 46 wide outsole and applanate polyps smaller than 1.0 cm located at ultra-lower rectum in 17 cases of patients were treated by contact-mode APC under U-type retroflex colonoscopy after failure in regular colonoscopic treatment. Then observe the contacting rate of APC probe with polyps, success rate of curing polyps, rate of probe being adhered and blocked by the solidification structures,incidence of submucosal emphysemas, and incidence of colonoscope ambustion. Results Under U-type retroflex colonoscopy, the probe could contact with polyps in 17 patients. The polyps in every patient were cured by APC in the first time of colonoscopic treatment, whereas all 46 polyps were cured by 97 times of APC spurt. Mild adhesions occurred between the probe and solidification structures at 5 times（5.15 %） among 97 times of APC spurt, without injuries to the coagulation surface from which when the probe separated. The solidification structures blocked the probe only twice（2.06 %）. When the solidification structures were cleared, efficiency of the probe restored. No submucosal emphysemas and colonoscope ambustion happened. Conclusion Applying contact-mode APC for retroflex colonoscopic treatment of ultra-lower rectal polyps is safe and effective, it can prevent the damage of colonoscope from the argon knife.