门诊冷圈套切除术治疗老年结直肠小息肉的安全性和有效性分析

Analysis of the safety and efficacy of cold snare resection in the treatment of elderly patients with small colorectal polyps in outpatient department

目的探讨门诊冷圈套切除术(CSP)治疗老年结直肠小息肉的安全性和有效性,为治疗该病症提供方法。方法回顾性分析2018年1月—2018年10月于复旦大学附属华东医院消化内镜行大肠小息肉切除的325例老年患者的临床资料,依据不同治疗方法分为CSP(冷圈套切除术)组(n=186)、HSP(热圈套切除术)组(n=94)和EMR(内镜下黏膜切除术)组(n=45);CSP组分为门诊亚组(n=68)和住院亚组(n=118)。评估并比较各组的手术操作时间、术中出血、术后出血、穿孔和完整切除率等情况。结果 CSP组有较低术中出血率和较短的手术操作时间(P<0.05);3组术后出血穿孔率和病理分型的差异无统计学意义(P> 0.05);CSP门诊亚组和住院亚组相比的术中出血率、术后出血率及穿孔率均无统计学差异(P> 0.05)。结论门诊CSP切除老年患者结直肠小息肉,具有较高的安全性和有效性、较高的完整切除率、较低的术中出血率、几乎为0的术后出血和穿孔率,手术时间更短,手术费用较低,具有一定的临床应用价值。

Objective To study the safety and efficacy of cold snare polypectomy(CSP)for small colorectal polyps in elderly patients in outpatient department. Methods The clinical data of325 elderly patients who underwent endoscopic small colorectal polypectomy in Huadong Hospital Affiliated to Fudan University from January to October2018 were analyzed retrospectively. According to different resection methods,they were divided into CSP group(n= 186),HSP(hot snare polypectomy)group(n= 94)and EMR(endoscopic mucosal resection)group(n= 45). CSP group was further divided into outpatient subgroup(n= 68)and inpatient subgroup(n=118). The operation time,intraoperative bleeding,postoperative bleeding,perforation and complete resection rate and etc of each group were evaluated and compared. Results The CSP group had lower intraoperative bleeding rate and shorter operation time(P< 0.05). There was no significant difference in postoperative bleeding rate,perforation rate and pathological type among the three groups(P> 0.05). There was no significant difference in intraoperative bleeding rate,postoperative bleeding rate and perforation rate between CSP outpatient subgroup and CSP inpatient subgroup(P> 0.05). Conclusion In the outpatient department,resection of small colorectal polyps with CSP in elderly patients has high safety and effectiveness,high complete resection rate,low intraoperative bleeding rate,almost without postoperative bleeding and perforation,shorter operation time and lower operation cost,which is worth to be popularized in clinical practice.