冷圈套切除抗凝治疗患者结肠小息肉的研究

Advantage of cold snare resection for anticoagulant therapy in patients with small colonic polyps

目的研究冷圈套在抗凝患者结肠小息肉中的安全性,争取为接受抗凝治疗患者结肠小息肉切除找到安全、便捷的方法。方法选取在该院门诊及住院部接受抗凝治疗并结肠镜检查发现结肠息肉(直径3~8 mm)的60例患者为研究对象,将其随机分为冷圈套组与高频电凝电切组,每组各30例,分别采用冷圈套技术、高频电凝电切技术切除息肉。比较两组患者在息肉的位置、大小、数量、切除时间、术中及术后两周的出血率、结肠息肉的完整切除率、标本回收率、病理学检查结果及病理标本中黏膜下层的小动脉血管损伤情况。结果两组平均年龄(46.76±8.52)岁,在性别、肠镜指征、肠道准备评分及回肠末端插管成功率等方面差异均无统计学意义(P>0.05),具有可比性;冷圈套组切除息肉操作时间(3.26±0.84)min,高频电凝电切组(5.17±1.25)min,两组差异具有统计学意义(P<0.05);冷圈套组息肉的完整切除率为100.00%(57/57),高频电凝电切组为88.68%(47/53),两组差异具有统计学意义(P<0.05);两组患者平均切除息肉数、息肉直径、位置、术中出血率、术后两周出血率及息肉标本回收率差异均无统计学意义(P>0.05);两组患者的病理分型及特异性差异均无统计学意义(P>0.05);冷圈套组切除标本中黏膜下层的小动脉血管未发生损伤,高频电凝电切组有7例受损,两组差异均有统计学意义(P<0.05)。结论对切除接受抗凝治疗患者,冷圈套比较传统的高频电凝电切切除结肠小息肉具有更便捷、病理的判断更准确等优势,但限于单中心、样本量偏低等条件的限制,冷圈套技术在我国针对接受抗凝治疗患者的疗效与优势仍有待进一步研究。

Objective To study the safety of cold snare in colon polyps of anticoagulant patients. Finding a safe and convenient way to remove small polyps in the colon in patients receiving anticoagulant therapy. Methods In our hospital outpatient and inpatient colonoscopy findings of colonic polyps （3 - 8 mm diameter） of the 60 patients received anticongulation treatment as the research object, randomly divided into cold trap group and high frequency electrocoagulation group, 30 cases in each, using cold trap technology, high frequency electrocoagulation technology excision of polyps respectively. Comparison of the two groups of patients with polyp location, size, quantity, resection time, intraoperative and postoperative bleeding rate, the rate of complete resection of colonic polyps, sample recovery rate, pathological examination results and pathological specimens in submucosal arteriole injury. Results The average age of the two groups was （46.76 ± 8.52） years, gender, colonoscopy indication, bowel preparation score and ileal intubation success rate differences has no significant difference （P 〉 0.05）, comparable; cold trap group polyps operation time （3.26 ± 0.84） min, the high frequency electrocoagulation group （5.17 ±1.25） min, the difference between the two groups was significant （P 〈 0.05）; cold trap group polyp complete resection rate was 100.00% （57/57）, high frequency electrocoagulation group was 88.68% （47/53）, the two groups had significant difference （P 〈 0.05）; the average number of the two groups of patients with polyps, polyp diameter, the location, intraoperative bleeding, postoperative bleeding and polyps from two weeks of recovery rate showed no significant difference （P 〉 0.05）; the two groups of patients with pathological type and specific differences had no statistically significance （P 〉 0.05）; cold trap group specimens of stick ： there was no damage in the arteriole of the submucosa, and 7 cases in the high-frequency electrocoagulation group were impaired, and the difference between the two groups was significant （P 〈 0.05）. Conclusion For the resection of anticoagulation for patients with high frequency, electric coagulation and cold trap compared to traditional small polyps excised colon has more secure, convenient and accurate pathological and other advantages, but limited to the single center, low sample size conditions, cold trap technology by therapeutic effect and advantages of anticoagulant therapy in patients still need to be further studied.