儿童结直肠息肉98例的临床特征及腹腔镜联合结肠镜下手术治疗效果

Clinical characteristics of 98 cases of colorectal polyps in children and the efficacy of laparoscopic surgery combined with colonoscopy

目的调查与分析儿童结直肠息肉的临床特征及腹腔镜联合结肠镜下手术对其的治疗效果。方法选择2019年2月—2021年10月在郑州大学附属儿童医院诊治的98例结直肠息肉患儿,记录患儿的临床特征,根据患儿的手术方法分为腹腔镜组(腹腔镜联合结肠镜下手术治疗,n=40)与结肠镜组(采用结肠镜手术治疗,n=58),对比不同手术方法的治疗效果、并发症发生率、疼痛视觉模拟评分法(VAS)评分、息肉复发与再手术率。结果98例患儿中,息肉部位为直肠44例、横直肠38例、其他16例;息肉最大直径(1.65±0.24)cm;息肉单发83例、多发15例。腹腔镜组的围手术期指标比结肠镜组改善(P<0.05)。腹腔镜组术后7 d的感染、出血、肠穿孔、肠梗阻等并发症发生率为5.00%,低于结肠镜组的17.24%(P<0.05)。腹腔镜组术后1个月的总有效率为97.50%,高于结肠镜组的82.76%(P<0.05)。腹腔镜组术后1、3、7 d的疼痛VAS评分低于结肠镜组(P<0.05)。所有患儿术后随访1年,联合的息肉复发率与再次手术率为5.00%、2.50%,均低于结肠镜组的18.97%、13.79%(P<0.05)。结论儿童结直肠息肉主要位于直肠、横直肠,多为单发,腹腔镜联合结肠镜下手术治疗能促进患儿康复,提高总体治疗效果,也能缓解患儿疼痛,减少并发症的发生,降低随访息肉复发率与再次手术率。

Objective To investigate and analyze the clinical features of children with colorectal polyps and the efficacy of laparoscopic surgery combined with colonoscopy.Methods A total of 98 children with colorectal polyps diagnosed and treated in our hospital from February 2019 to October 2021 were selected as subjects of this study.The clinical characteristics of all children were recorded,and they were divided into the laparoscopic group(laparoscopic surgery combined with colonoscopy,n=40)and the colonoscopy group(colonoscopy,n=58)according to the differences in surgical methods.The therapeutic effect,complication rate,VAS pain score,polyp recurrence and reoperation rate of different surgical methods were compared.Results Among the 98 children,the polyps of 44 cases were in rectum,38 cases in transverse rectum and 16 cases in other sites.The maximum diameter of polyp was(1.65±0.24)cm.Polyps were solitary in 83 cases and multiple in 15 cases.The perioperative indexes in the laparoscopic group were significantly improved compared with those in the colonoscopy group(P<0.05).The incidence of postoperative complications such as infection,bleeding,intestinal perforation and intestinal obstruction was 5.00%in the laparoscopy group,which was significantly lower than 17.24%in the colonoscopy group(P<0.05).The total effective rate of laparoscopic group was 97.50%one month after operation,which was significantly higher than that of colonoscopy group(82.76%,P<0.05).The VAS pain score of the laparoscopic surgery group was significantly lower than that of the colonoscopy group at 1,3 and 7 days after surgery(P<0.05).After 1 year of follow-up,the combined polyp recurrence rate and reoperation rate were 5.00%and 2.50%,which were significantly reduced compared with 18.97%and 13.79%in colonoscopy group(P<0.05).Conclusions The main sites of colorectal polyps in children are rectum and transverse rectum,and most of them are solitary.Laparoscopic and colonoscopic surgery for colorectal polyps in children can promote the recovery of children,improve the overall treatment effect of patients,relieve the pain of children,reduce the occurrence of complications,and reduce the recurrence rate and reoperation rate of follow-up polyps in children.