冷圈套切除术治疗老年结直肠息肉的临床效果研究

目的 探究冷圈套切除术治疗老年结直肠息肉的临床效果,为治疗老年结直肠息肉提供方法.方法 回顾性分析2017年1月～2019年12月期间安徽医科大学第三附属医院消化内科住院治疗的211例老年结直肠息肉患者的临床资料,依据不同治疗方法分为观察组(n=110)和对照组(n=101).观察组息肉回收样本238粒,对照组息肉回收...     

冷圈套切除术应用于结直肠息肉治疗的研究进展

部分结直肠息肉有一定风险转变为结直肠癌,对结直肠息肉行内镜下切除可显著降低结直肠癌的发病率。在临床上应用较多的息肉切除术包括内镜下黏膜切除术、内镜下黏膜剥离术、热圈套切除术、冷圈套切除术等,临床医师可根据息肉的大小、形状、生长部位及病理类型选择合适内镜切除方式进行治疗。冷圈套切除术作为一项新兴技术被广泛应用于10 mm以内的结直肠小息肉的内镜切除,其安全性和有效性已被很多研究充分证明。近年来,冷圈套切除术及相关技术也被运用于其他类型结直肠息肉的切除。本文就冷圈套切除术在临床应用方面的进展作一概述。     

冷圈套切除较大结直肠息肉的临床研究

目的探讨内镜下采用冷圈套息肉切除术（cold snare polypectomy, CSP）与热圈套息肉切除术（hot snare polypectomy, HSP）治疗10~15 mm结直肠息肉的有效性及安全性。方法采集2019年12月—2020年12月间接受结肠镜检查、发现至少1枚10~15 mm息肉、并行结肠镜下切除患者资料154例,息肉173枚,形态表现为巴黎分型Ⅰsp、Ⅰs或Ⅱa。按随机数字表法将息肉随机分成CSP组（息肉85枚）和HSP组（息肉88枚）。比较两组手术方式在息肉大小、位置、形态、组织学分类、完全切除率、并发症发生率、切除时间、金属夹使用数量等方面的情况。结果两组患者在年龄、性别、肠镜指征、回肠末端插管成功率方面差异无统计学意义。两组息肉在大小、位置、形态、组织学分类上具有可比性。CSP组在息肉完全切除率、术中出血率、术后延迟出血、穿孔等方面与HSP组比较,差异亦无统计学意义。但CSP组手术时间明显短于HSP组[（63.5±23.6）s比（184.3±62.4）s,P<0.05],使用金属夹亦明显少于HSP组[（0.8±0.5）枚比（1.4±0.7）枚,P<0.05],差异有统计学意义。结论CSP与HSP在切除10~15 mm结直肠无蒂息肉上有相似的完全切除率和并发症发生率,但CSP手术时间更短,金属夹使用数量更少。     

结直肠息肉冷圈套器切除术与传统热切除安全性及有效性对照研究

目的 比较冷圈套器切除与传统热切除治疗结直肠息肉的安全性及有效性。方法 选取2018年1月到2020年1月深圳市罗湖区人民医院收治的结肠息肉(<1 cm)患者374例,采用随机数字法将其分为对照组和观察组,每组各187例。对照组患者行与传统热圈套器切除治疗,观察组患者行冷圈套器切除治疗。比较两组患者的息肉完整切除率、单个息肉切除时间、钛夹使用率、息肉回收率及并发症发生率。结果 两组的息肉完整切除率和息肉回收率比较均无统计学意义(P>0.05);观察组的单个息肉切除时间和钛夹使用率均明显低于对照组(P<0.05);观察组的术中即刻出血明显高于对照组(P<0.05);观察组的迟发性出血明显低于对照组(P<0.05);两组患者均未出现迟发性穿孔及感染,组间比较无统计学意义(P>0.05)。结论 冷圈套器切除与传统热切除对<1 cm的结直肠息肉的完整切除效果均较好,但冷圈套器切除操作更为简便,且安全性更高,值得在临床推广。     

冷圈套切除术对≤10 mm肠息肉的疗效与安全性分析

目的 探讨冷圈套切除术(CSP)对于≤10 mm肠息肉的疗效与安全性.方法 收集2018年5月1日至2020年1月1日深圳市罗湖区人民医院≤10 mm息肉的CSP及热圈套器切除术(HSP)病例456例,分析其切除完整性、手术时间、手术费用、术后出血率、穿孔率、感染率,探讨CSP治疗疗效与安全性.结果 两组病例一般资料、...     

结直肠息肉冷切除术相关研究进展

结直肠癌是全球人类高发恶性肿瘤之一,结肠镜下肠息肉切除已被证实可降低结直肠癌的发生率。因此,肠息肉切除术及相关技术逐渐成为内镜医师研究及改进的焦点。目前,根据息肉的大小、形态、部位及不同的组织学类型,常用的内镜下息肉切除术选择众多,各种传统的切除方法多数会使用电凝功能,迟发性出血、穿孔等并发症发生率较高。冷息肉切除技术因其操作简单、手术时间短、完整切除率高、伤口愈合快、迟发性出血、穿孔率低等优点,逐渐被内镜医师应用,本文对冷息肉切除术及相关研究进行一综述。     

CSP与EMR治疗结直肠小息肉临床疗效及安全性对比分析

目的 对比圈套器冷切除术(CSP)与内镜下黏膜切除术(EMR)治疗结直肠广基小息肉临床临床疗效及安全性。方法 收集2021年7月至2021年12月本院收治的80例结直肠广基小息肉患者临床资料,80例患者根据治疗方式不同分为EMR组(EMR治疗)39例与CSP组41(CSP治疗)。对比两组手术指标、息肉切除情况、应激反应指标、并发症情况。结果 两组住院时间比较无差异(P>0.05),CSP组手术时间、息肉切除时间均明显短于EMR组(P<0.05);两组在息肉整块切除、组织学完全切除率、回盲部插管、息肉回收率中比较,差异无统计学意义(P>0.05);术前两组NLR、白细胞、CRP比较无差异(P>0.05),术后NLR、白细胞、CRP水平均出现明显上升(P<0.05),而CSP组术后NLR、白细胞、CRP水平均明显低于EMR组(P<0.05);EMR组术后并发症总发生率为7.69%,CSP组为2.43%,术后两组并发症总发生率比较无差异(P>0.05)。结论 CSP与EMR治疗结直肠广基小息肉均可有效完整切除息肉,临床疗效相当,但CSP对患者创伤更小...     

冷圈套联合黏膜下注射对结直肠(微)小息肉的完整切除率的研究

目的肠镜下切除的结直肠息肉绝大多数为微小息肉(≤5 mm)或小息肉(6～10 mm),对于此类息肉的最佳切除方法目前缺乏统一指南。本研究旨在探究冷圈套息肉切除术联合黏膜下注射治疗结直肠息肉(直径≤10 mm)的可行性和有效性。 方法本研究前瞻性随机选取2018年1月至2018年12月经解放军联勤保障部队第九〇〇医院消化内科行结肠镜检查发现结直肠息肉(直径≤10 mm)的300例患者进行对照研究,按1∶1随机分配接受冷圈套息肉切除术联合黏膜下注射(CSPI)或冷圈套息肉切除术(CSP)治疗。其中CSPI组在切除息肉之前先进行黏膜下注射,再行息肉切除,而CSP组则套取息肉后直接切除,然后在内镜窄带成像技术(NBI)引导下对息肉切除部位底部及侧切缘活检2～3块,用于病理组织学评估切除完整率。术中记录息肉切除时间、息肉回收情况和并发症。 结果纳入研究的300例患者,CSPI组(n ＝150)和CSP组(n＝150)病灶平均大小分别为7.7 mm和6.7 mm。患者的性别、年龄等及息肉部位、大小、形态、分型在组间均衡。CSPI与CSP相比完全切除率为96.7% vs 76.6%,差异具有统计学意义(P<0.001)。所有息肉均回收,其中9例CSP患者出现术中出血,CSPI组无术中出血,差异具有统计学意义(P<0.05);所有患者均无迟发性出血、穿孔等并发症。 结论尽管CSPI较单纯采用冷圈套的治疗时间长,但却是一种安全、有效的息肉切除术,尤其对于6～10 mm息肉其全切除率高达98.9%,并且手术相关并发症发生率较低。     

结直肠大息肉的内镜下治疗

尽管大多数学者认为内镜下切除息肉是一个可行的措施，但是对于大息肉的治疗人们仍存在争议。本研究的目的是评价内镜下切除大息肉的可行性、有效性及安全性。     

结直肠息肉内镜下圈套器冷切除的临床疗效与安全性

目的 比较圈套器冷切除(CSP)与圈套器热切除(HSP)在结直肠息肉切除中的临床疗效与安全性.方法 回顾性分析2019年5月至2021年2月柳州市人民医院及鹿寨县人民医院接受结直肠息肉治疗的患者,分为HSP组及CSP组(共有息肉92枚,其中CSP组48枚,HSP组44枚),比较两组在整块切除率、完全切除率、术中出血、迟...     

Colorectal cold snare polypectomy: Current standard technique and future perspectives

It has been shown that resection of adenomatous colorectal polyps can reduce mortality due to colorectal cancer. In daily clinical practice, simpler and safer methods of colorectal polypectomy have been sought to enable endoscopists to resect all detected lesions. Among these, cold snare polypectomy (CSP) is widely used in clinical practice because of its advantages in shortening procedure time, reducing delayed bleeding risk, and lowering treatment costs, while maintaining a similar complete resection rate for lesions smaller than 10 mm when compared to conventional hot snare polypectomy. This review introduces the findings of previous studies that investigated the efficacy and safety of the CSP procedure for nonpedunculated polyps smaller than 10 mm, and describes technical points to remember when practicing CSP based on the latest evidence, including using a thin wire snare specifically designed for CSP, and observing the surrounding mucosa of the resection site with chromoendoscopy or image-enhanced endoscopy to ensure that there is no residual lesion. This review also describes the potential of expanding the indication of CSP as a treatment for lesions larger than 10 mm, those with pedunculated morphology, those located near the appendiceal orifice, and for patients under continuous antithrombotic agent therapy. Finally, the perspective on optimal treatments for recurrent lesions after CSP is also discussed, despite the limited related evidence and data.     

Cold snare endoscopic resection of nonpedunculated colorectal polyps larger than 10 mm: a systematic review and pooled-analysis

1. Download high-res image (304KB)
2. Download full-size image

     

Safety and efficacy of cold snare polypectomy for small colorectal polyps: A prospective randomized control trial and one-year follow-up study

Trial design:Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy.Methods:Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate.Results:A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06).Conclusions:Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.     

Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta‐analysis

Background and Aim

Safety and effectiveness of cold snare polypectomy (CSP) compared with hot snare polypectomy (HSP) has been reported. The aim of the present study is to carry out a meta‐analysis of the efficacy and safety of HSP and CSP.

Methods

Randomized controlled trials were reviewed to compare HSP with CSP for resecting small colorectal polyps. Outcomes reviewed include complete resection rate, polyp retrieval, delayed bleeding, perforation and procedure time. Outcomes were documented by pooled risk ratios (RR) with 95% confidence intervals (CI) using the Mantel‐Haenszel random effect model.

Results

Eight studies were reviewed in this meta‐analysis, including 1665 patients with 3195 polyps. Complete resection rate using HSP was similar to CSP (RR: 1.02, 95% CI: 0.98–1.07, P = 0.31). Polyp retrieval after HSP was similar to CSP (RR: 1.00, 95% CI: 1.00–1.01, P = 0.60). Delayed bleeding rate after HSP was higher than after CSP, although not significantly (patient basis: RR: 7.53, 95% CI: 0.94–60.24, P = 0.06; polyp basis: RR: 7.35, 95% CI: 0.91–59.33, P = 0.06). Perforation was not reported in all eight studies. Total colonoscopy time for HSP was significantly longer than CSP (mean difference 7.13 min, 95% CI: 5.32–8.94, P < 0.001). Specific polypectomy time for HSP was significantly longer than CSP (mean difference 30.92 s, 95% CI: 9.15–52.68, P = 0.005).

Conclusion

This meta‐analysis shows significantly shorter procedure time using CSP compared with HSP. CSP tends toward less delayed bleeding compared with HSP. We recommend CSP as the standard treatment for resecting small benign colorectal polyps.     

内镜下氩离子凝固术治疗老年人大肠息肉

目的探讨内镜下氩离子凝固术（APC）治疗老年人大肠息肉的安全性和有效性。方法采用德国ERBE公司生产的APC（VIO200D型）内镜专用氩气刀对电子肠镜检查发现的大肠息肉进行内镜下治疗。结果258例老年患者共检出525枚息肉全部使用APC治愈,根据息肉大小和形态,使用APC灼除302枚（57．5％）,APC切除89枚（17％）,黏膜下注射后APC切除134枚（25．5％）,局部渗血者行APC电凝或钛夹止血。术后2例（0．8％）出现少量便血,予药物治疗后出血停止,无穿孔和大出血等严重并发症。结论APC可作为老年人大肠息肉的首选治疗,安全性高,并发症少。