内镜下不同方法切除结直肠息肉的效果评价

Effect evaluation of endoscopic resection of colorectal polyps by different methods

目的探讨内镜下不同切除方法切除结直肠息肉的临床疗效。方法回顾性分析2019年1月至2020年3月于甘肃省人民医院内镜诊疗中心行内镜下结直肠息肉切除的1121例患者的内镜及病理资料,所有患者根据内镜下息肉特征采取不同切除方式,并分为冷活检钳钳除组、冷圈套器切除(CSP)组、热圈套器切除组、内镜下黏膜切除术(EMR)组、内镜下黏膜下剥离术(ESD)组。分析患者一般情况及息肉病理特征,分析内镜治疗结果,比较各组手术指标(息肉最大径、手术时间)、结直肠息肉病理特征(息肉大体形态、组织学类型、病理学类型)、治疗效果(整块切除率、完全切除率)及并发症发生率。结果1121例患者中,共发现息肉3122枚,男性息肉数多于女性,差异有统计学意义(P<0.05);每例患者随机选出1枚有术后病理检查的息肉,最终纳入1121枚息肉,中位直径0.85(0.3~3.0)cm;息肉大体形态以非侧向发育型肿瘤(LST)(97.23%)为主,组织学类型以管状腺瘤(71.63%)为主,病理学类型以低级别上皮内瘤变(79.13%)为主,息肉部位以乙状结肠至降结肠(43.62%)最多,横结肠至升结肠(34.43%)次之。1121例患者均顺利完成内镜下息肉切除治疗。其中114例行冷活检钳钳除(冷活检钳钳除组),629例行CSP(CSP组),277例行热圈套器切除(热圈套器切除组),86例行EMR(EMR组),15例行ESD(ESD组)。不同切除方式息肉最大径、手术时间比较差异有统计学意义(P<0.05)。ESD组息肉最大径、手术时间>EMR组>热圈套器切除组>CSP组>冷活检钳钳除组,差异有统计学意义(P<0.05)。不同切除方式息肉大体形态、组织学类型、病理学类型比较差异有统计学意义(P<0.05);但不同切除方式整块切除率、完全切除率、并发症发生率比较差异均无统计学意义。结论内镜下切除结直肠息肉需根据息肉特征合理选用适宜的切除方式,以减少操作相关并发症发生,提高息肉整块、完全切除率。

Objective To investigate the clinical effect of endoscopic resection of colorectal polyps by different methods.Methods The endo-scopic and pathological data of 1121 patients who underwent endoscopic colorectal polyp resection in the Endoscopic Diagnosis and Treatment Cen-ter of Gansu Provincial People's Hospital from January 2019 to March 2020 were retrospectively analyzed,all patients underwent different resection methods according to the characteristics of endoscopic polyps,they were divided into the cold biopsy forceps removal group,the cold snare polypec-tomy(CSP)group,the hot snare polypectomy group,the endoscopic mucosal resection(EMR)group and the endoscopic submucosal dissection(ESD)group according to the endoscopic polypectomy.The general condition and pathological characteristics of polyps of the patients were ana-lyzed,and the results of endoscopic treatment were analyzed,the surgical indicators(maximum diameter of polyps,operation time),pathological characteristics of colorectal polyps(gross morphology,histological type and pathological type of polyps),therapeutic effects(total resection rate and complete resection rate)and complication rate were compared among the each groups.Results Among the 1121 patients,3122 polyps were found,and the number of polyps in males was more than that in females,the difference was statistically significant(P<0.05).One polyp with postoperative pathological examination was randomly selected from each patient,and 1121 polyps were finally included,with a median diameter of 0.85(0.3-3.0)cm;the gross polyp morphology was mainly non-laterally spreading tumors(LST)(97.23%),the histological type was mainly tubular adenoma(71.63%),the pathological types were mainly low-grade intraepithelial neoplasia(79.13%),the most polyps were from sigmoid colon to descending colon(43.62%),followed by transverse colon to ascending node(34.43%).Endoscopic polypectomy was successfully completed in 1121 patients,among them,114 were treated with cold biopsy forceps removal(cold biopsy forceps group),629 were treated with CSP(CSP group),277 were treat-ed with hot snare(hot snare group),86 were treated with EMR(EMR group),and 15 were treated with ESD(ESD group).There were significant dif-ferences in the maximum diameter of polyps and operation time among different resection methods(P<0.05);the maximum polyp diameter and op-eration time in the ESD group>EMR group>the hot snare polypectomy group>the CSP group>the cold biopsy forceps removal group,the dif-ferences were statistically significant(P<0.05).There were significant differences in gross morphology,histological type and pathological type of polyps in different resection methods(P<0.05),but there were no significant differences in the overall resection rate,complete resection rate and complication rate among different resection methods.Conclusions Endoscopic resection of colorectal polyps requires reasonable selection of appro-priate resection methods according to the characteristics of polyps,so as to reduce the occurrence of operation-related complications and increase the overall and complete resection rate of polyps.