无痛消化内镜下高频电刀在胃肠息肉中的应用效果及术后复发影响因素分析

Application Effect of High-frequency Electrotome Under Painless Digestive Endoscope in Gastrointestinal Polyps and Analysis of Influencing Factors of Postoperative Recurrence

目的 调查无痛消化内镜下高频电刀在胃肠息肉中的应用效果及术后复发的影响因素。方法 回顾性搜集2020年6月至12月空军军医大学第一附属医院消化内镜中心手术治疗的胃肠息肉患者500例,其中124例接受常规内镜下高频电刀治疗记为常规组,376例采用无痛消化内镜下高频电刀治疗记为研究组,比较两种内镜方案在息肉切除效率、围术期镇痛及胃肠恢复方面的应用效果;另外对研究组展开为期3年的术后随访研究,并据此总结为复发与未复发两种结局,单因素及二元logistic回归调查术后复发的影响因素。结果 两组术中息肉切除数目差异不显著(P>0.05),但研究组息肉切除时间短于常规组(P<0.05)。研究组术中及术后0.5、1、6 h的疼痛水平均低于常规组(P<0.05)。两组术后第1次肛门排气、排便时间差异均不显著(P>0.05)。研究组患者术后3年内息肉复发141例,复发率37.50%,单因素及二元logistic回归调查显示,年龄≥49岁、超重、合并Hp感染、腺瘤性息肉、多发息肉以及息肉直径≥1 cm均是胃肠息肉患者无痛消化内镜下高频电刀治疗后3年内复发的独立危险因素(P<0.05)。结论 无痛消化内镜下高频电刀治疗胃肠息肉患者的息肉切除效率较高且围术期镇痛效果满意,但术后仍具有一定复发率,临床需对其合并有年龄≥49岁、超重、Hp感染、腺瘤性息肉、多发息肉以及息肉直径≥1 cm等类特征的患者加强随访监督管理,预防术后复发。

Objective To investigate the application effect of high-frequency electrotome under painless digestive endoscope in gastrointestinal polyps and the influencing factors of postoperative recurrence.Methods From June to December,2020,500 patients with gastrointestinal polyps were retrospectively collected.Among them,124 patients were treated with high-frequency electrotome under conventional endoscope as the routine group,and 376 patients were treated with high-frequency electrotome under painless digestive endoscope as the research group.The application effects of the two endoscopic schemes in polypectomy efficiency,perioperative analgesia and gastrointestinal recovery were compared.In addition,the study group was followed up for 3 years after operation,and the results were summarized as recurrence and non-recurrence.Univariate and bivariate logistic regression were used to investigate the influencing factors of postoperative recurrence.Results There was no significant difference in the number of polypectomy between the two groups(P>0.05),but the polypectomy time in the study group was shorter than that in the routine group(P<0.05).The pain level in the study group was lower than that in the routine group at 0.5 h,1 h and 6 h after operation(P<0.05).There was no significant difference in the time of first anal exhaust and defecation between the two groups(P>0.05).In the study group,there were 141 cases of polyp recurrence within 3 years after operation,and the recurrence rate was 37.50%.Univariate and bivariate logistic regression surveys showed that age ≥49 years,overweight,Hp infection,adenomatous polyp,multiple polyps and polyp diameter ≥1 cm were independent risk factors for the recurrence of gastrointestinal polyps within 3 years after high-frequency electrotome treatment under painless digestive endoscope(P<0.05).Conclusion High-frequency electrotome under painless digestive endoscope has high efficiency in polypectomy and satisfactory analgesic effect in perioperative period,but it still has a certain recurrence rate after operation.Clinically,it is necessary to strengthen the follow-up supervision and management of patients with characteristics such as age ≥49,overweight,Hp infection,adenomatous polyp,multiple polyps and polyp diameter ≥1 cm to prevent postoperative recurrence.