钛夹预先蒂部结扎联合高频电切治疗大肠带蒂息肉的临床效果

Clinical Effect of Titanium Clip Pre-pedicle Ligation Combined with High-frequency Electrotomy in the Treatment of Colorectal Pedunculated Polyps

目的:观察在内镜下切除大肠带蒂息肉时预先用钛夹在息肉蒂部结扎预防出血的临床效果。方法:选取2017年6月—2020年7月我院内镜中心收治的大肠息肉患者370例,随机分为试验组182例(息肉198枚),对照组188例(息肉222枚),试验组预先用钛夹在息肉蒂部结扎再行高频电切除术结合中医辨证施治治疗肠息肉,对照组单纯高频电切除术结合中医辨证施治,并进行术后3~9个月随访,分析组间术后病理,术中术后出血、穿孔差异及创面愈合情况。结果:两组患者大肠息肉均完整切除。术后病理诊断及分型差异无统计学意义。试验组无术中出血、穿孔,无术后迟发性穿孔,术后便血1例(0.55%)。对照组术中出血8例(4.26%),无术后迟发性穿孔,术后便血14例(7.45%)。试验组术中出血及术后便血等并发症发生率低于对照组,差异有统计学意义。结论:对带蒂大肠息肉预先用钛夹在息肉蒂部结扎,预防出血更具有优势,提高了大息肉内镜下的切除率,显著降低了内镜治疗发生出血、穿孔的风险,其安全性和有效性值得肯定。

Objective To observe the clinical effect of preliminarily ligating the polyp pedicle with a titanium clip during endoscopic resection of the pedicled polyp of the large intestine to prevent bleeding.Methods A total of 370 patients with intestinal polyps diagnosed by endoscopy in our hospital from June 2017 to July 2020 were randomly divided into test group(182 cases,198 polyps)and control group(188 cases,222 polyps).The test group was ligated with titanium clip in the pedicle of polyp,and then treated with high-frequency electric resection combined with TCM syndrome differentiation.The control group was treated with high-frequency electric resection combined with TCM syndrome differentiation,and followed up for 3-9 months after operation.The postoperative pathology,intraoperative and postoperative bleeding,perforation difference and wound healing were analyzed.Results The colorectal polyps of both groups were completely removed.There was no statistically significant difference in pathological diagnosis and classification after operation.In the test group,there was no intraoperative bleeding,perforation,no delayed postoperative perforation and 1 case(0.55%)with postoperative blood in the stool.In the control group,8 cases(4.26%)had intraoperative bleeding,no delayed postoperative perforation and 14 cases(7.45%)had blood in the stool after operation.The incidence of complications such as intraoperative bleeding and postoperative blood in the stool in the test group was lower than that in the control group,which the difference was statistically significant.Conclusion Preliminary ligation of pedicled colorectal polyps with a titanium clip at the polyp pedicle is more advantageous to prevent bleeding,which improves the endoscopic resection rate of large polyps and significantly reduces the risk of bleeding and perforation in endoscopic treatment.Its safety and effectiveness is worthy of recognition.