内镜下高频电凝圈套切除联合APC治疗0.5~1.0 cm结直肠扁平息肉的疗效探讨

Efficacy of endoscopic high-frequency electrocoagulation with a snare device combined with APC in the treatment of flat colorectal polyps sized 0.5-1.0 cm

目的探讨内镜下高频电凝圈套切除联合氩离子凝固术(APC)治疗0.5~1.0 cm结直肠扁平息肉的效果。方法100例(163枚息肉)0.5~1.0 cm结直肠扁平息肉患者,根据手术方法不同分为试验组(50例,83枚息肉)和对照组(50例,80枚息肉)。试验组患者给予内镜下高频电凝圈套切除联合APC治疗,对照组患者给予内镜下高频电凝圈套切除治疗。比较两组息肉一次性切除率、并发症发生情况及随访1年内复发情况。结果试验组中80枚息肉用高频电凝圈套联合APC切除一次完成,残端用氩离子进一步凝固直至息肉表面变白。对照组中65枚息肉用高频电凝圈套切除一次完成,残端用活检钳或热活检钳切除。试验组息肉一次性切除率96.39%高于对照组的81.25%,差异有统计学意义(P<0.05)。试验组中2例患者因广基息肉电凝切除后创面较深有少量出血,用钛夹夹住创面,未出现迟发性出血、穿孔等并发症;3例患者术后有腹部胀痛不适等表现,经卧床休息1 d后完全缓解。对照组术后未出现出血、穿孔等并发症,2例患者术后有腹部胀痛不适等表现,经卧床休息1 d后完全缓解。两组并发症发生率比较差异无统计学意义(P>0.05)。试验组术后1年内复发率0低于对照组的14.00%,差异有统计学意义(P<0.05)。结论采用内镜下高频电凝圈套切除联合APC治疗0.5~1.0 cm结直肠扁平息肉,完整切除率得到有效提高,且并发症未明显增加,复发率低,值得临床推广应用。

Objective To explore the effect of high-frequency electrocoagulation with a snare device combined with argon plasma coagulation(APC)in the treatment of flat polyps of the colon and rectum sized 0.5-1.0 cm.Methods A total of 100 patients(163 polyps)with colorectal polyps sized 0.5-1.0 cm were divided into an experimental group(50 cases,83 polyps)and a control group(50 cases,80 polyps)according to different surgical method.The experimental group received endoscopic high-frequency electrocoagulation with a snare device combined with APC treatment,while the control group received endoscopic highfrequency electrocoagulation with a snare device.The one-time resection rate of polyps,complications,and the recurrence rate during the 1-year follow-up of the two groups were compared.Results In the experimental group,80 polyps were excised once with high-frequency electrocoagulation with a snare device combined with APC,and the stumps were further coagulated with argon ions until the surface of the polyps turned white.In the control group,65 polyps were excised once with high-frequency electrocoagulation with a snare device,and the stumps were excised with biopsy forceps or thermal biopsy forceps.The one-time resection rate of polyps in the experimental group was 96.39%,which was higher than 81.25%in the control group,and the difference was statistically significant(P<0.05).In the experimental group,2 patients had a small amount of bleeding due to the deep wound after electrocoagulation resection of broad-based polyps,and the wound was clamped with titanium clips,and there were no complications such as delayed hemorrhage and perforation;3 patients had postoperative abdominal distension and discomfort,which were completely relieved after 1 d of bed rest.In the control group,there were no complications such as bleeding and perforation,and 2 patients had abdominal distension and discomfort after surgery,which was completely relieved after 1 d of bed rest.There was no significant difference in complication rate between the two groups(P>0.05).The recurrence rate within 1 year after surgery in the experimental group was 0,which was lower than 14.00%in the control group,and the difference was statistically significant(P<0.05).Conclusion In the treatment of flat colorectal polyps sized 0.5-1.0 cm,endoscopic high-frequency electrocoagulation with a snare device combined with APC can effectively improve the complete resection rate,without significantly increasing complications,and has a low recurrence rate,which is worthy of clinical promotion and application.