IT刀联合钛夹和透明帽治疗结直肠带蒂大息肉的效果研究

Insulated-tip knife combined with titanium clips and transparent cap in treatment of large pedunculated colorectal polyps

目的探讨内镜下应用IT刀联合钛夹和透明帽治疗结直肠带蒂大息肉的有效性和安全性。方法在透明帽辅助下,用钛夹夹闭大息肉蒂部阻断其血供,后用IT刀电切蒂部以切除息肉。通过回顾2014年1月-2015年12月在中国人民解放军第一七五医院消化内科运用此方法治疗结直肠带蒂大息肉(息肉直径≥2.0 cm)的45例临床资料,统计治疗操作时间、所用钛夹数量和并发症发生情况等,分析应用此方法切除大息肉的治疗效果。结果 45枚大息肉均一次切除,其中有3例患者创面出现少量渗血,其余术中无出血、穿孔;术后均无迟发性出血及穿孔并发症发生。平均使用钛夹2.7枚,操作时间3~12 min,平均(5.7±1.2)min。结论联合应用IT刀、钛夹、透明帽治疗结直肠带蒂大息肉安全、有效,操作较为便捷省时。

Objective To evaluate the efficacy and safety of combined use of insulated-tip knife, titanium clips and transparent caps in the resection of large pedunculated colorectal polyps. Methods Therapeutic method： with the assistance of transparent cap, 1-3 titanium clip（s） were applied to the base of the stalk to block blood supply of large polyps and then insulated-tip knife was utilized to resect polyps by cutting the stalk. Research method： retrospectively analyze the clinical data of 45 large pedunculated colorectal polyps （head 〉 2.0 em） which were treated by the method mentioned above from January 2014 to December 2015. Statistics of procedure time, clip numbers, complication rates were used to assess the effect of the treatment. Results 45 large polyps were successfully removed one time without any severe complications of bleeding or perforation during procedure except a very small amount of blood were oozing from the cutting edge in 3 cases. There were also no delayed complications of bleeding or perforation after procedure. The average number of titanium clip was 2.7 and the average operating time was （5.7 ± 1.2） min （range 3 - 12 min）. Conclusion Combined application of insulated-tip knife, titanium clips and transparent cap in the resection of large pedunculated colorectal polyps is safe, effective and convenient to conduct.