内镜下预处理结肠粗蒂息肉预防切除术后出血的研究

Preventive effect of endoclip and endoloop on post-polypectomy hemorrhage of colorectal stalks polyps

目的评估金属夹及尼龙圈套在预防结肠粗蒂息肉切除术后出血的效果。方法选择2015年8月至2018年8月经海军军医大学附属长海医院虹口院区消化内科就诊,息肉顶部直径>10 mm同时蒂部直径>5 mm的息肉患者85例为研究对象。根据息肉预处理方法的不同分为预先金属夹夹闭组(A组)和预先金属夹联合尼龙圈套套扎组(B组)。回顾性分析每组患者息肉形态、部位、大小、病理类型及术中,术后出血发生率、金属夹使用数量、息肉残留率、息肉复发率等指标。结果 A组和B组息肉形态以山田Ⅲ、Ⅳ型为主,主要位于直肠和乙状结肠,两组患者性别、年龄、息肉顶部、蒂部平均直径相比均无明显差异(P>0.05)。A组和B组的术中出血发生率(6.4%对0,P>0.05)、术后迟发性出血发生率(1.6%对2%,P<0.05),术中和术后迟发性出血均经内镜治疗后停止。A组3例患者术后3个月息肉基底部残留;B组患者术后3个月手术创面良好,息肉基底部无残留,息肉无复发。结论对于蒂部直径超过5 mm的粗蒂息肉,预先使用金属夹和尼龙圈套可有效预防息肉切除术后出血,是否联合使用需要根据蒂的长短和直径具体决定。

Objective To evaluate effects of endoclip and endoloop in preventing postoperative hemorrhages after colorectal stalks polypectomy.MethodsEighty-five patients with polyps who came for consultation in our hospital from August 2015 to August 2018 and whose diameter of polyp was over 10mm as well as stalk diameter over 5mm were chosen to be research objects.The patients were divided into endoclip group and endocilp combined endoloop ligation group according to different pretreatment method of polyps.Polyps morphology,location,size,pathological types and intraoperative and postoperative hemorrhage rate,metal clips used,polyps residual rate,recurrence rate of polyps and other indexes of each patients were retrospectively analyzed.ResultsPolyps morphology were mainly YamadaⅢandⅣ,and mainly located in rectum and sigmoid colon in group A and B.There was no obvious difference regarding gender,age,top polyps,average diameter of Pericles in the two groups(P>0.05).Intraoperative hemorrhage rate as well as postoperative tardive hemorrhage rate in group A and B was(6.4%vs 0%,P>0.05)and(1.6%vs 2%,P<0.05)respectively.After endoscopic treatment,intraoperative and postoperative tardive hemorrhage were stopped.Three patients in group A suffered from residual in polyp base three months after operation.While three months after operation,surgical wounds of patients in group B were good and there was no residual in polyp base as well as no polyp recurrence.ConclusionFor thick stalk polyps whose diameter was over 5mm,use of pretreated endocclip and endoloop could effectively prevent postoperative hemorrhage of polypoectomy and combined use of the two methods will be decided by the length and diameter of the pedicure according to detailed situations.