3种不同内镜方法治疗结肠粗蒂大息肉的对比研究

Comparison of three endoscopic resection methods for large colon polyps with thick pedicle

目的通过比较3种不同内镜方法治疗结肠粗蒂大息肉的疗效及安全性,探讨治疗结肠粗蒂大息肉安全、有效的内镜治疗方案。方法 2014年1月至2017年12月收治的98例共124枚结肠粗蒂大息肉患者根据治疗方法不同分为单纯高频电切除组(简称单纯切除组)、尼龙绳结扎联合高频电切除组(简称尼龙绳组)、黏膜下注射后高频电切除组(简称黏膜下注射组),分别予以单纯高频电切除、尼龙绳结扎联合高频电切除、黏膜下注射后高频电切除治疗,比较3组不同治疗方法的完全切除率、出血及穿孔发生率、术后住院天数、操作时间、使用器械费用等。结果 3组结肠息肉的完全切除率均为100.0%,尼龙绳组未发生出血、穿孔等并发症,单纯切除组术中出血3例、迟发出血1例、迟发穿孔1例,黏膜下注射组发生术中出血1例、迟发出血2例;单纯切除组的术后住院天数大于尼龙绳组和黏膜下注射组[(3.56±1.43)比(3.00±0.00)、(3.12±0.48)d,均P<0.05];黏膜下注射组的操作器械费用高于单纯切除组和尼龙绳组[(1 186.0±67.77)比(864.4±121.8)、(878.4±82.12)元,均P<0.05]。结论尼龙绳结扎联合高频电切除治疗结肠粗蒂大息肉的疗效可靠、安全性高、医疗费用低,可作为结肠粗蒂大息肉的首选内镜治疗方案,值得临床推广应用。

Objective To compare the safety and efficacy of three endoscopic resection methods for large colon polyps with thick pedicle. Methods Ninety eight patients with colon polyps(124 polyps) scheduled to receive endoscopic resection in Taizhou First People’s Hospital from January 2014 to December 2017 were assigned in three groups according to their different treatments: patients were treated by high-frequency electric resection only(only resection group), by high-frequency electric resection combined with nylon cord ligation(nylon cord group), or by high-frequency electric resection combined with submocusal saline injection(submocusal injection group), respectively. The rate of polyp complete resection, rate of complications(bleeding and perforation), average post-operation hospital day, average time of procedure and cost of endoscopic use were compared among these three groups. Results The rate of polyp complete resection was 100% in all of the three groups. In nylon cord group, there was no bleeding and perforation case;in only resection group, intraoperative bleeding and postoperative bleeding occurred in 3 and 1 patients, respectively, and post-operation perforation occurred in 1 patient;in submocusal injection group,there were 1 case of intraoperative bleeding and 2 cases of postoperative bleeding. The average post-operation hospital day in only resection group was significantly longer than that in nylon cord group and submocusal injection group(3.56±1.43 vs 3.00±0.00, 3.12±0.48 days, all P<0.05). The cost of endoscopic use in submocusal injection group was significantly higher than that in only resection group and nylon cord group(1 186.0 ±67.7 vs 864.4 ±121.8, 878.4 ±82.12 CNY, all P <0.05). Conclusion Colonscopy nylon cord ligation combined with high-frequency electric resection is safe, economical, effective and reliable, and it can be the first choice for the resection of large colon polyps with thick pedicle.