内镜下高频电切除联合残端套扎治疗带蒂息肉临床研究

Clinical Research on Endoscopic High-frequency Electric Resection Combined with Stump Ligation in the Treatment of Pedunculated Polyps

目的研究内镜下高频电切除联合残端套扎治疗带蒂息肉的临床效果。方法选取2022年1月—2023年1月黔东南苗族侗族自治州人民医院住院患者80例,以随机数表分为观察组、对照组,各40例。对照组采用高频电圈套切除,予钛夹夹闭创面或尼龙绳预先结扎息肉根部,观察组采用高频电圈套切除,予橡皮圈套扎息肉残端。比较两组患者的围术期指标、术后并发症、随访情况。结果观察组患者的手术时间、术中止血时长短于对照组,出血量少于对照组,差异有统计学意义(P<0.05)。观察组患者术后并发症发生率为5.00%(2/40),低于对照组的25.00%(10/40),差异有统计学意义(χ^(2)=6.275,P<0.05)。术后随访,观察组创面瘢痕形成,未见复发,对照组有2例创面黏膜增生,差异有统计学意义(P<0.05)。结论针对结直肠息肉带蒂直径10~35 mm,内镜下高频电圈套切除后息肉残端用橡皮圈套扎治疗,可快速简便地切除息肉病变,并有效阻断息肉残端的血管,避免息肉切除术后出血、穿孔、电凝综合征和感染等不良事件。

Objective To study the clinical effect of endoscopic high-frequency electrical resection combined with stump ligation in the treatment of pedunculated polyps.Methods A total of 80 patients hospitalized in Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from January 2022 to January 2023 were selected.Accord⁃ing to the random number table,they were divided into observation group and control group,40 cases each.The con⁃trol group was excised with high-frequency electric snare,and the wound was closed with titanium clip or the root of polyp was lapped with nylon rope.The observation group was excised with high-frequency electric snare,and the stump of polyp was lapped with rubber band.The perioperative indexes,postoperative complications and follow-up were compared between the two groups.Results The operation time and intraoperative hemostatic time of observation group were shorter than control group,and the blood loss was less than control group,the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 5.00%(2/40),lower than that in the control group 25.00%(10/40),and the difference was statistically significant(χ^(2)=6.275,P<0.05).Post⁃operative follow-up showed that scar formation and no recurrence were observed in the observation group,while there were 2 cases of wound mucosal hyperplasia in the control group,the difference was statistically significant(P<0.05).Conclusion For colorectal polyp pedicle(10~35 mm in diameter),rubber band lapping treatment of polyp stump after endoscopic high-frequency electric snare resection can quickly and easily remove polyp lesions,effectively block the blood vessels of the polyp stump,and avoid adverse events such as bleeding,perforation,electrocoagulation syndrome and infection after polypectomy.