儿童大肠息肉的内镜下特征及治疗

Endoscopic characteristics and treatment of colorectal polyps in children

目的探讨儿童大肠息肉的临床、内镜、组织病理学特征及不同内镜治疗方式的应用,为儿童大肠息肉的临床诊治提供参考价值。方法回顾性分析2015年1月—2023年6月361例确诊为大肠息肉并行无痛结肠镜检查及治疗的14岁以下患儿的临床资料。结果儿童大肠息肉以男性多见,共245例(67.87%),女性116例(32.13%)。好发年龄为学龄前期,占比44.88%。最常见的症状为便血(86.70%)。单发息肉288例(79.78%),多发息肉73例(20.22%)。患儿息肉主要位于左半结肠(347例,96.12%)。不同年龄段患儿的临床表现与息肉数量差异有统计学意义(P<0.05)。459枚息肉行内镜下息肉切除术,均成功切除。252例(69.81%)患儿有术中出血,金属钛夹夹闭为最常用的止血方法,有186例(73.81%)。复发患儿共有12例(3.32%),多发息肉患儿更易复发(P<0.001)。结论大肠息肉多见于男性患儿,最常见的临床症状为便血,学龄前期好发,息肉多见于左半结肠,单发多见,形态以山田Ⅳ为主,大息肉最多,组织病理学以幼年性息肉为主。不同形态及大小的息肉内镜处理方式不同,微小无蒂息肉主要采用冷活检钳钳除术,巨大息肉及有蒂息肉主要采用高频电凝圈套切除术,小息肉及无蒂息肉主要采用内镜下黏膜切除术。

Objective To explore the clinical,endoscopic,and histopathological characteristics of colorectal polyps in children,as well as the application of different endoscopic treatment methods,so as to provide reference value for the clinical diagnosis and treatment of colorectal polyps in children.Methods The clinical data of 361 children under 14 years of age diagnosed with colorectal polyps and undergoing painless colonoscopy examination and treatment were retrospectively analyzed.Results Colorectal polyps in children are more commonly seen in males(245 cases,67.87%)compared to females(116 cases,32.13%).The most prevalent age group is the preschool period,accounting for 44.88%(162/361)of all patients.The most common symptom is hematochezia,observed in 86.70%(313/361)of cases.There were 288 cases(79.78%)with a single polyp and 73 cases(20.22%)with multiple polyps.The polyps in children are mainly located in the left half of the colon(347 cases,96.12%).The clinical manifestations and the number of polyps differ significantly across different age groups of children(P<0.05).Endoscopic polypectomy was performed on 459 polyps,all of which were successfully removed.Intraoperative bleeding occurred in 252 cases(69.81%),and metallic titanium clip closure was the most commonly used hemostasis method(186 cases,73.81%).There were 12 patients with recurrence(3.32%),and the patients with multiple polyps were more likely to relapse(P<0.001).Conclusions Colorectal polyps are more commonly found in male children,with hematochezia being the most frequent clinical symptom.They are prevalent during the preschool age,often located in the left half of the colon,and usually appear as single formations.The predominant morphology is Yamada type IV,with large polyps being the most common.Histopathologically,juvenile polyps are the primary type.Polyps of different shapes and sizes were treated by different endoscopic methods.Micro polyps without a stalk are mainly treated using cold forceps polypectomy;giant polyps and those with a stalk are primarily removed using hot snare polypectomy;small polyps and those without a stalk are mainly treated using endoscopic mucosal resection.