少儿Peutz--Jeghers综合征患者小肠内镜治疗价值研究息肉

Therapeutic value of balloon-assisted endoscopy for small-bowel polyps of children with Peutz- Jeghers syndrome

目的探讨气囊辅助内镜对少儿Peutz—Jeghers综合征（PJS）患者小肠息肉的治疗价值，并对其临床应用安全性进行评价。方法回顾性总结中国人民解放军空军总医院2004年4月至2015年9月问对56例少儿PJS患者（年龄4～18岁）小肠息肉的内镜诊治情况，并与同期接受内镜诊治的160例成人PJS患者（19～57岁）进行对比研究。结果56例PJS患儿中53例共行153次（经口93次、经肛60次）气囊辅助内镜检查及治疗，3例仅接受胃镜及结肠镜诊治。共切除小肠息肉757枚（经口686枚、经肛71枚）。术中出血率16．98％（9／53），术后出血率7．55％（4／53），穿孔率9．43％（5／53，术中穿孔2例、术后穿孔3例）。160例成人PJS患者中150例共行418次（经口248次、经肛170次）气囊辅助内镜检查及治疗，10例仅接受胃镜及结肠镜诊治。共切除小肠息肉2320枚（经口2036枚、经肛284枚）。术中出血率19．33％（29／150），术后出血率5．33％（8／150），穿孔率2．67％（4／150，均为术后穿孔）。2组PJS患者术中出血率及术后出血率差异均无统计学意义（P〉0．05），但少儿组小肠穿孔率高于成人组（P〈0．05）。结论气囊辅助内镜是治疗少儿PJS小肠息肉的一种有效方法，但有一定风险，比成人患者更易并发小肠穿孔。

Objective To study the therapeutic effect and safety of balloon-assisted endoscopy （BAE） for small intestinal polyps of children with Peutz-Jeghers syndrome（PJS）. Methods Clinical data of 56 children（ aged 4-18）and 160 adults with PJS treated at Air Force Hospital from April 2004 to September 2015 were analyzed retrospectively and compared. Results A total of 153 BAE procedures（ 93 peroral and 60 peranal）were performed in 53 of 56 children with PJS, and a total of 757 （686 peroral and 71 peranal） small intestinal polyps were removed by BAE. Three underwent endoseopy only.The incidences of intraopera- tive hemorrhage, postoperative hemorrhage and perforation were 16. 98% （9/53）, 7.55% （4/53）and 9.43% （5/53）, respectively. A total of 418 BAE procedures（ 248 peroral and 170 peranal）were performed in 150 of 160 adult patients with PJS, and a total of 2 320 small intestinal polyps（ 2 036 peroral and 284 peranal） were removed by BAE. Ten underwent endoseopy only.The ineidenees of intraoperative hemorrhage, postop- erative hemorrhage and perforation were 19. 33% （ 29/150）, 5.33% （8/150） and 2. 67% （ 4/150）, respee- tively. There were no significant differences in the incidences of intraoperative hemorrhage or postoperative hemorrhage between pediatric group and adult group（ P〉0. 05）, while the incidence of perforation was higher in pediatrie group than that in adult group（P〈0. 05）. Conclusion Despite the risks, it is effective for pedi- atric patients to receive BAE endoscopie therapy for intestinal polyps.