大肠幼年性息肉内镜治疗后随访

幼年性息肉目前多采用内镜下治疗,但幼年性息肉切除后的随访,国内尚未见报道。本文报告69例幼年性息肉患者内镜下治疗后的随访情况,讨论幼年性息肉的再检出率,影响再检出率的因素及随访时间的安排。     

内镜下黏膜切除术治疗小儿结肠幼年性息肉的临床价值

幼年性息肉又称黏液性或潴留性息肉,属于肠道错构瘤性息肉,好发于小儿,常因便血而就诊[1-3].近年来,随着结肠镜的普及和内镜下黏膜切除术（EMR）的广泛应用,小儿幼年性息肉的诊断率和治愈率得到极大的提高.现回顾我院采用内镜下黏膜切除术治疗小儿结肠幼年性息肉的资料,报道如下.     

65例成人大肠幼年性息肉的内镜特点及病理分析

幼年性息肉是儿童消化道息肉的主要病理类型，6-10岁患儿90%以上属于幼年性息肉，6岁以下者接近100%，而在成人侧少见，我们回顾了近十年来在我院经病理证实的65例成人大肠幼年性息肉的临床，内镜及病理特点，并复习国内外相关文献，报道如下。     

幼年性息肉内镜切除115例临床分析

与成人腺瘤性息肉相比,幼年性息肉是儿童胃肠道最常见的息肉类型,也是儿童下消化道出血最常见病因.随着结肠镜诊疗技术的发展,儿童幼年性息肉可经结肠镜检查明确诊断,并在结肠镜下进行安全而有效的治疗.我院1994年至2009年经结肠镜切除幼年性息肉115例,疗效满意,报道如下.     

儿童结直肠幼年性息肉40例临床特征及治疗预后分析

［摘要］　目的　分析儿童结直肠幼年性息肉（JP）临床特征及内镜下黏膜切除术(EMR)治疗该病的疗效。方法　回顾性分析2017年1月至2021年5月柳州市妇幼保健院收治的40例JP患儿的临床资料。其中男31例,女9例;年龄7个月～12岁,中位年龄5岁。均为结直肠单发JP。对其临床特征和治疗预后进行总结。结果　40例JP生长部位在直肠23例(57.50%),乙状结肠12例(30.00%),降结肠3例(7.50%),横结肠1例(2.50%),升结肠1例(2.50%)。息肉直径≤0.5 cm者2例(5.00%),0.6～1.0 cm者17例(42.50%),1.1～2.0 cm者15例(37.50%),>2.0 cm者6例(15.00%)。直径最小为0.5 cm,最大为5.0 cm。山田分型为Ⅳ型19例(47.50%),Ⅲ型11例(27.50%),Ⅱ型9例(22.50%),Ⅰ型1例(2.50%)。40例标本中有17例(42.50%)提示有慢性炎症改变,18例(45.00%)见小脓肿形成,未发现不典型增生及息肉恶变情况。本组患儿除2例术后10 d内偶有少量便血外,其余均无感染、穿孔及大出血等严重并发症发生,2个月后临床症状均消失。9例轻度贫血患儿术后2个月复查血红蛋白均恢复正常。22例术后复查肠镜,未见复发。结论　儿童结直肠JP好发于直肠、乙状结肠,EMR+金属夹治疗JP安全性高,疗效好,值得临床推广应用。     

成人大肠幼年性息肉25例内镜特点分析

幼年性息肉(Juvenile Polyp)又称粘液性或潴留性息肉,属于肠道错构瘤性息肉.以往认为幼年性息肉主要见于儿童,16岁以后少见.随着纤维、电子结肠镜的广泛应用,成人大肠幼年性息肉的内镜检出率明显增高.为了提高对成人大肠幼年性息肉的认识,我们对25例成人大肠幼年性息肉的内镜特点作一回顾性分析.     

成人胃幼年性息肉和幼年性息肉病临床病理特征及癌变趋势探讨

幼年性息肉 (juvenilepolyp,JP)是儿童胃肠道息肉的常见类型,而在成人消化道息肉中,JP所占的比例较低,且大多分布在直、结肠,在胃内罕见。以往研究的重点多放在幼儿JP的发病上,对成人JP尤其是成人胃幼年性息肉 (juvenilpolypofstomach,JPS)和胃幼年性息肉病 (juvenilepolyposisyndromeofstomach,JPSS)的观察鲜有报道。本研究通过对本院确诊的 6例成人JPS和 3例JPSS进行回顾性临床病理分析,对其发病情况、病理演变规律做初步探讨。一、对象与方法　　1.临床资料:本院近 20年共检出胃息肉 1318例,检出率为 1. 2%,其中JPS9例 (0.…     

内镜下高频电切治疗小儿结肠巨大息肉1例

笔者在青岛大学附属医院学习期间，遇到1例小儿结肠巨大息肉，并成功的进行了内镜下高频电切治疗，现报道如下。     

双气囊内镜对小肠息肉的内镜诊治研究

目的 探讨双气囊内镜(DBE)对小肠息肉镜下治疗的可行性及安全性.方法 回顾分析我院自2003年11月～2009年6月接受DBE检查并检出小肠息肉的所有病例,总结和分析小肠息肉的内镜诊断及治疗情况,并评价其安全性.结果 360例患者,共进行566例次DBE检查及治疗,其中检出小肠息肉患者66例(Peutz-Jeghers综合征患者50例,其他小肠息肉患者16例).66例患者共接受122例次DBE镜下治疗(经口 74次,经肛48次).镜下切除小肠息肉共计1 012枚(直径5～10 mm 95枚、1～30mm 599枚,直径31～50 mm 274枚,直径大于50 mm 44枚).66例患者在DBE检查及治疗前86例次有不同的临床症状(不完全肠梗阻36例、消化道出血32例、腹痛及腹部不适18例),其中78例次(90.7%)经内镜治疗后临床症状均明显缓解或消失,另有8例次因小肠息肉巨大(7例)或发现息肉恶变(2例)转外科手术治疗.发生较严重的并发症共6例次(小肠穿孔3例,术后有3例出现引起血红蛋白水平下降的消化道出血).结论 DBE能安全有效地切除小肠多发息肉,可在一定范围内代替外科手术治疗,为小肠息肉患者提供了一种安全有效的微创治疗方法,具有重要的临床应用价值.     

Endoscopic management of large colorectal polyps

Objectives  The optimal treatment for large colorectal polyps (LCPs) is still a controversial issue. The aim of this study was to evaluate the safety and effectiveness of endoscopic polypectomy (EP) of colorectal polyps ≥2 cm in size. Patients and methods  One hundred fifty-one EP LCPs were performed over a period of 7 years. Diathermal snare was used for pedunculated and pseudopedunculated polyps and endoscopic mucosal resection (EMR) or biopsy forceps polypectomy for sessile and flat polyps. The resected polyps were recovered and collected for histology. At scheduled follow-up visits 1, 3, 6, and 12 months after polypectomy, complications and recurrences were recorded in all patients. Results  Fifteen polyps were located in the rectum, 84 in the sigmoid colon, 11 in the descending colon, four in the splenic flexure, 11 in the transverse colon, 11 in the hepatic flexure, seven in the ascending colon and eight in the cecum. Fifty-six polyps were sessile, 54 pedunculated, 25 pseudopedunculated, and 16 flat. At histology, most of polyps (131) were adenomas (nine with adenocarcinoma in situ). Five were invasive polypoid carcinomas and required colonic resection. Immediate bleeding occurred in ten patients (7.6%) and it was stopped by endoscopic hemoclips (7), epinephrine injection (1), or surgery (2). There were three perforations (2.3%; all polypoid carcinomas), managed endoscopically (1) or surgically (2). Delayed bleeding occurred in two patients (1.5%) and was treated by endoscopic diathermy and hemoclips (1) or surgery (1). During follow-up, six (4.6%) incompletely excised polyps and three (2.3%) relapses in the site of previous EP were detected and endoscopically removed. Conclusion  EP is relatively safe and effective for benign-appearing LCPs.     

Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps

Objective. Large sessile or flat colorectal polyps, which are traditionally treated surgically, may be amenable to endoscopic mucosal resection (EMR), often using a piecemeal method. Appropriate selection of lesions and a careful technique may enhance the efficacy of EMR for polyps ≥20 mm in diameter without compromising safety. The aim of this study was to identify the factors that may be predictive of the risk of polyp recurrence. Material and methods. A retrospective analysis was conducted on the outcome of 161 polyps ≥20 mm in diameter, treated by piecemeal EMR at a single centre using the “lift and cut” technique. All records were reviewed for polyp size, site, morphology and histology. Polypectomy technique, patient follow-up, polyp recurrence and surgical interventions were also recorded. Results. Over an 8-year period, 161 colonic polyps measuring ≥20 mm were removed by EMR. Follow-up data were available for 149 cases (93%) with a mean polyp diameter of 32.5 mm; the total success rate of endoscopic polyp removal was 95.4%. The number of cases requiring 1, 2, 3, 4 and 6 attempts at EMR was 89 (60%), 36 (24%), 14 (9%), 2 (1.3%) and 1 (0.7%), respectively. Recurrence was significantly related to polyp size (p<0.001). There was no statistically significant relationship between site and recurrence. Seven patients (4.6%) underwent surgical intervention after EMR because of failed clearance. There were no post-EMR perforations and significant bleeding was reported in only two patients (1.7%). Conclusions. With careful attention to technique, piecemeal EMR is a safe option for the resection of most sessile and flat colorectal polyps ≥20 mm in size. A stricter follow-up may be required for larger lesions because of a higher risk of recurrence.     

Endoscopic management of colorectal polyps: From benign to malignant polyps

Colorectal cancer(CRC) is the third most common cancer worldwide and the second leading cause of cancer related death in the world. The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality. Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps. Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps. Polyp size, location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability. Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically. When compared to surgery, endoscopic resection is associated with lower morbidity, mortality, and higher patient quality of life. Conversely, malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery. From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics, but also on local resources and expertise availability. In this review, we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.     

FICE技术10组波长对大肠息肉的诊断价值

目的:探讨FICE放大内镜10组波长组合对大肠息肉的观察效果,并选出最佳波长组合.方法:选择武汉大学人民医院 2007-05/2010-05进行常规内镜检查,资料保存完整的大肠息肉患者378例.采用FICE放大技术预先设定的10组波长分别对病变进行腺管开口分型及毛细血管形态观察,并对图像清晰度进行评分,选出最佳波长组合...     

Endoscopic treatment of colorectal benign-appearing lesions 3 cm or larger

PURPOSE: Colonoscopic polypectomy is the preferred technique to remove the majority of polyps. The authors evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps equal to or larger than 3 cm. METHODS: Ninety-seven patients with 104 giant polyps underwent polypectomy within a nine-year period. The majority of these procedures were performed on an outpatient basis, all on unsedated patients. Gross appearance, size, location, histologic characteristics, synchronous lesions, modality, and adequacy of removal of giant polyps were analyzed. The follow-up was achieved in 89 percent of patients during a period ranging from 6 to 96 months (median, 38). RESULTS: Of the 104 removed polyps, 75 (72 percent) were adenomatous, 2 (2 percent) were hyperplastic, and 27 (26 percent) were malignant polyps. Six patients had more than one giant polyp. Several additional smaller polyps were found in 52 patients and a synchronous cancer in 4. Twenty-one (20 percent) giant polyps were equal to or larger than 4 cm. Forty-nine were pedunculated, 20 were short-stalked, and 35 were sessile. Sixty-one polyps were excised in one piece, and forty-three were excised using a piecemeal technique. Only four complications (3.8 percent) were recorded; all cases were treated endoscopically. Fifty-eight (75 percent) adenomas and eighteen (67 percent) malignant polyps were completely excised. Surgery was performed in 7 of 27 patients (27 percent) with malignant polyps, where there was a doubtful, infiltrated margin or poorly differentiated cancer. Post-polypectomy surveillance permitted the detection and treatment of 25 metachronous or recurrent polyps and a metachronous cancer. CONCLUSIONS: This study shows that polypectomy of giant colorectal polyps, performed by an expert endoscopist, is feasible, effective, and safe, even on an outpatient basis. The authors confirm that malignant polyps with incomplete excision, lymphovascular invasion, and poor differentiation require bowel resection. Post-polypectomy surveillance is useful for all patients who have undergone colonoscopic resection of giant adenomatous or malignant polyps.Supported by the University of Parma, Parma, Italy.     

Physician accuracy in diagnosing colorectal polyps

Since the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. Although many physicians have grown confident that their skills of visual diagnosis are adequate, few data exist to support this confidence. In order to examine the accuracy of physicians' judgments regarding colorectal polyp histology, the visual diagnosis of physicians experienced in endoscopy was compared with the histologic report. Eighty-one polyps were discovered by flexible sigmoidoscopy among 718 participants in a colon cancer screening program. Eighty percent of all polyps were detected accurately. The diagnostic sensitivity of detecting adenomas was 69 percent, while specificity (accurate diagnosis of hyperplastic polyps) was 86 percent, and there were an additional eight false negative and eight false positive diagnoses. Further analyses revealed that there are individual patterns of diagnostic mistakes made by physicians and that mistakes frequently are related to polyp size. These findings are particularly important in light of the expanding numbers of relatively inexperienced primary care providers performing flexible sigmoidoscopy whose diagnoses may be strongly dependent on polyp size. This research was done through, and supported by, the Center for Occupational Health, Department of Family Medicine, Wayne State University, Detroit, Michigan.     

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps： A single operator study

AIM: To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS: All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS: A total of 240 lesions were identified, of which 158 (65.8%) were non-neoplastic and 82 (34.2%) were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% (183/240) and 95.4% (229/240), respectively (P< 0.001) CONCLUSION: The combination of colonoscopy and magnified chromoendoscopy is the most reliable non-biopsy method for distinguishing the non-neoplastic from the neoplastic lesions.