内镜息肉冷切除术治疗结直肠小息肉的临床效果

目的 研究内镜息肉冷切除术（CSP）治疗结直肠小息肉的临床效果。方法 选取2020年1月－2022年1月该院收治的118例结直肠小息肉（直径≤10 mm）患者作为研究对象,采用随机抛硬币法分为对照组（n = 59）和观察组（n = 59）,对照组采用内镜息肉热圈套切除术（HSP）治疗,观察组采用内镜CSP治疗,比较两组患者息肉切除情况、手术指标、息肉切除率、术中、术后并发症和复发情况等。结果 观察组手术操作时间短于对照组,差异有统计学意义（P < 0.05）;观察组组织学完整切除率和直径1～5 mm息肉切除率高于对照组,差异均有统计学意义（P < 0.05）;观察组术中出血率、术后2周出血率和内镜下止血率低于对照组,差异均有统计学意义（P < 0.05）。结论 内镜CSP治疗结直肠小息肉,手术操作时间短,息肉切除率高,术中和术后并发症少,是一种安全、有效的治疗方式。     

内镜下冷圈套器和热圈套器切除结直肠小息肉疗效和安全性研究的Meta分析

目的 评价采用冷圈套器或热圈套器切除结直肠小息肉（直径≤10 mm）的有效性和安全性,并进行Meta分析。方法 计算机检索2010年－2020年中国知网、维普和PubMed等数据库发表的关于比较冷圈套器和热圈套器切除结直肠小息肉疗效的临床研究,根据纳入和排除标准筛选文献。采用RevMan 5.3软件对符合纳入标准的文献进行Meta分析。观察指标包括：完整息肉切除率、息肉回收率、术后并发症和手术时间。结果 共纳入研究11篇,包括6 196例息肉。冷圈套器和热圈套器切除的完整息肉切除率比较,差异无统计学意义（91.96% vs 91.38%,P > 0.05,O = 0.79,95%CI：0.49～1.26）;息肉回收率比较,差异无统计学意义（97.63% vs 98.21%,P > 0.05,O = 0.91,95%CI：0.61～1.36）;术后并发症包括术后腹部不适、迟发性出血和穿孔,冷圈套器切除术（CSP）术后腹部不适发生率明显高于热圈套器切除术（HSP）（2.61% vs 0.34%,P < 0.05,O = 9.75,95%CI：1.16～82.11）,HSP的穿孔率高于CSP（0.17% vs 0.00%）,但两者比较,差异无统计学意义（P > 0.05,O = 0.21,95%CI：0.01～4.49）;HSP的迟发性出血率高于CSP（0.87% vs 0.08%,P < 0.05,O = 0.23,95%CI：0.07～0.80）;手术时间包括总操作时间和仅息肉切除时间,CSP的总操作时间（P < 0.05,MD = -7.44,95%CI：-9.29～-5.60）和仅息肉切除时间（P < 0.05,MD = -0.33,95%CI：-0.39～0.26）均短于HSP。结论 冷圈套器和热圈套器的息肉完整切除率和回收率比较,差异均无统计学意义;两种术式的穿孔率比较,差异亦无统计学意义;CSP术后腹部不适的发生率较HSP高,但迟发性出血率较低,且手术时间较短。建议切除≤ 10 mm的小息肉,优先选择CSP。     

内镜黏膜冷切除术和热切除术在结直肠6~10 mm无蒂息肉治疗中的疗效对比

目的：探讨黏膜下注射后内镜黏膜冷切除术和黏膜热切除术在治疗结直肠直径6~10 mm无蒂息肉中的疗效。方法：选取2016年1月至2017年6月江阴市中医院收治的因结直肠无蒂息肉（6~10 mm）拟行内镜切除的110例患者，共131枚息肉，随机分为冷切除组和热切除组。所有患者均于术中采用靛胭脂、生理盐水混合液进行黏膜下注射。分析2组患者病变完整切除率、手术时间、手术相关并发症发生率（包括术中出血或穿孔及术后1个月内迟发性出血或穿孔）及术后半年内息肉残留或复发率。结果：冷切除组55例患者，共62枚息肉，热切除组55例，共69枚息肉。2组息肉大小、位置、内镜形态和病理类型差异无统计学意义。冷切除组平均手术时间较热切除组明显缩短[（2.2±1.1）min vs（3.6±1.4）min，P<0.001]。冷切除组息肉完整切除率为95.2%，热切除组息肉完整切除率为91.3%，差异无统计学意义（P=0.599）。冷切除组术中出血1例，术后出血1例；热切除组术中出血2例，术中穿孔1例，术后出血1例，2组并发症差别无统计学意义（P=0.675）。术后半年复查肠镜，无息肉残留或复发。结论：黏膜下注射后内镜黏膜冷切除术是传统冷切除术的有效改良，可作为结直肠6~10 mm无蒂息肉的有效切除方式。     

内镜下高频电切术、氩离子束凝固术及黏膜切除术治疗结肠息肉的有效性和安全性

目的 探讨和分析内镜下高频电切术、氩离子束凝固术（APC）及黏膜切除术在结肠息肉治疗中的应用价值。方法 选取2017年6月－2018年6月该院行内镜下手术治疗的310例（息肉442枚）结肠息肉患者作为研究对象,根据患者病情分为内镜下高频电切术组150例（息肉203枚）、内镜下APC组40例（息肉66枚）和内镜下黏膜切除术（EMR）组120例（息肉173枚）,并分别对3组患者的临床治疗情况、生活质量改善情况和并发症发生情况进行比较和分析。结果 内镜下APC组总有效率95.00%和EMR组总有效率96.67%均较内镜下高频电切术组明显提高,而无效率5.00%和3.33%均明显降低,两两比较,差异有统计学意义（P < 0.05）。内镜下APC组和EMR组主观症状、生理功能、心理情绪、社会活动和消化病生存质量指数（GLQI）总分均较内镜下高频电切术组明显提高,两两比较,差异有统计学意义（P < 0.05）。EMR组患者出血和穿孔等并发症总发生率（0.83%）较内镜下高频电切术组明显降低,两组比较,差异有统计学意义（P < 0.05）。EMR组患者出血和穿孔等并发症总发生率较内镜下APC组略有降低,两组比较,差异无统计学意义（P > 0.05）。结论 内镜下APC和EMR在结肠息肉患者临床疗效、生存质量和安全性方面均优于内镜下高频电切术。     

预切开内镜下黏膜切除术与内镜黏膜下剥离术治疗十二指肠非壶腹部病变的疗效及安全性比较

目的 比较预切开内镜下黏膜切除术（Pre-cut-EMR）与内镜黏膜下剥离术（ESD）治疗十二指肠非壶腹部病变的临床疗效及安全性。方法 回顾性分析2015年6月－2021年6月宁波市医疗中心李惠利医院64例确诊为十二指肠非壶腹部病变的患者的临床资料。其中,30例行Pre-cut-EMR,34例行ESD。比较两组患者病灶特征、手术时间、并发症发生率、整块切除率、R0切除率和术后组织病理学结果。结果 两组患者病灶宏观形态、迟发性出血、整块切除率、R0切除率和术后病理等比较,差异均无统计学意义（P > 0.05）。所有患者均成功完成内镜下切除,整块切除率为100.0%,总体R0切除率为96.9%,术后均未发生迟发性穿孔。Pre-cut-EMR组手术时间为（24.6±6.5）min,明显短于ESD组的（37.5±9.5）min,术中穿孔率为3.3%（1/30）,明显低于ESD组的23.5%（8/34）,差异均有统计学意义（P < 0.05）。Pre-cut-EMR组病灶直径为1.40（1.30,1.70）cm,小于ESD组的1.45（1.30,2.00）cm,但差异无统计学意义（P > 0.05）;Pre-cut-EMR组病灶直径 ≥ 2.0 cm的比例为10.0%（3/30）,低于ESD组的32.4%（11/34）,差异有统计学意义（P < 0.05）。结论 Pre-cut-EMR和ESD治疗十二指肠非壶腹部病变的疗效相当,但Pre-cut-EMR手术时间更短,术中穿孔率更低,治疗直径 < 2.0 cm的病灶是安全有效的。     

单钳道内镜下荷包缝合术在结直肠内镜黏膜下剥离术后的临床应用

目的 探讨采用单钳道内镜下荷包缝合术夹闭结直肠内镜黏膜下剥离术（ESD）后创面的疗效及安全性。方法 回顾性分析2019年10月－2020年10月在东莞东华医院消化内科住院并诊断为结直肠病变行ESD术的220例患者的临床资料,共224处病变。根据ESD术后创面是否行荷包缝合术分为研究组（ESD术后行荷包缝合术夹闭创面,n = 121）和对照组（ESD术后创面不夹闭,n = 103）,总结两组患者治疗完成情况、并发症发生情况及随访结果。结果 病灶位于直肠114处（50.89%）,左半结肠56处（25.00%）,右半结肠36处（16.07%）,回盲部18处（8.04%）。研究组手术时间（73.12±12.23）min较对照组的（69.24±11.54）min长,但差异无统计学意义（P > 0.05）;研究组术后平均住院时间（3.85±0.98）d,较对照组的（5.04±1.24）d短,差异有统计学意义（P < 0.05）;研究组术后总体并发症发生率、术后出血发生率明显低于对照组,两组比较,差异均有统计学意义（P < 0.05）;研究组住院费用为（23 728.85±3 916.89）元,较对照组的（22 820.84±5 051.80）元多,但两组比较,差异无统计学意义（P > 0.05）;两组术后穿孔、发热和腹痛腹胀发生率比较,差异均无统计学意义（P > 0.05）。结论 单钳道内镜下荷包缝合术能有效夹闭结直肠ESD术后创面,缩短术后住院时间,减少术后出血,降低总体并发症发生率,安全性高,不增加总体住院费用,值得临床推广应用。     

水下与常规内镜下黏膜切除术治疗大肠息肉有效性及安全性的Meta分析

目的 比较常规内镜下黏膜切除术（CEMR）与水下内镜下黏膜切除术（UEMR）两种治疗方法在切除大肠息肉方面的有效性及安全性。方法 检索近5年（2016年1月－2021年1月）发表在PubMed、Embase、Cochrane Library、中国知网（CNKI）、中国生物医学文献数据库（CBM）及万方等数据库有关UEMR及CEMR治疗大肠息肉的对比研究,采用Review Manager 5.3.5软件对两种手术方式的整块切除率、治愈性切除率、复发率、不良事件发生率、术中出血、迟发性出血和穿孔等多个方面进行Meta分析。结果 共纳入10篇文献,涉及1 954名患者,2 351个息肉病变。其中,UEMR组1 151个,CEMR组1 200个。Meta分析的结果显示：与CEMR相比,UEMR在整块切除率（RR＾ = 1.10,P = 0.000）、治愈性切除率（RR＾ = 1.36,P = 0.000）及切除时间（MD = -8.06,P = 0.030）上更具优势,并有更低的术后复发率（RR＾ = 0.45,P = 0.000）、不良事件发生率（RR＾ = 0.69,P = 0.020）和术中出血率（RR＾ = 0.58,P = 0.003）,但迟发性出血和穿孔方面,两者差异均无统计学意义（P > 0.05）。结论 UEMR是一种安全、有效并可以替代CEMR的技术方法,值得在临床推广应用。     

内镜下圈套器冷切除术对结直肠小息肉患者息肉完整切除率及应激反应的影响

目的 探讨内镜下圈套器冷切除术(CSP)对结直肠小息肉患者息肉完整切除率及应激反应的影响。方法 选取结直肠小息肉患者138例为研究对象,按照单盲随机分组法分为对照组(n=69)和观察组(n=69)。对照组行内镜下圈套器热切除术(HSP),观察组行CSP。比较2组患者息肉切除时间、手术时间、住院时间、完整切除率以及肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平,术后6个月时息肉新生率与息肉复发率。结果 观察组息肉切除时间、手术时间、住院时间均短于对照组,差异有统计学意义(P<0.05); 2组术后E、NE、Cor、CRP和IL-6水平均较术前升高,但观察组低于对照组,差异有统计学意义(P<0.05)。结论 CSP与HSP治疗结直肠小息肉患者的完整切除率相近,但CSP的应激反应和炎症反应更轻,更有利于患者恢复。     

无痛内镜下冷切除术在老年患者5～9 mm扁平无蒂结直肠息肉治疗中的临床应用价值

目的 探讨无痛内镜下冷切除术在老年患者5～9 mm扁平无蒂结直肠息肉治疗中的临床应用价值。方法 选取在开封市人民医院内镜中心行无痛肠镜检查,发现扁平无蒂结直肠息肉且直径在5～9 mm的124例老年患者为研究对象,按照随机数表法分为研究组（n=64）和对照组（n=60）。研究组应用圈套器对息肉行冷切除治疗,对照组给予黏膜下注射使息肉抬举后,应用圈套器行高频电切除治疗。比较两组患者手术时间、术中出血量、一次性完整切除率、标本回收率、息肉病理类型、术后并发症及手术费用。结果研究组手术时间较对照组短,手术费用较对照组少,术后并发腹胀的情况较对照组少,差异均有统计学意义（P <0.05）;两组患者术中出血例数、一次性完整切除率、标本回收率、术后并发腹痛和出血比较,差异均无统计学意义（P> 0.05）。结论 无痛内镜下应用圈套器对5～9 mm扁平无蒂结直肠息肉行冷切除术,手术时间短,安全性高,并发症少,费用低,且避免了高频电对周围正常黏膜的损伤。     

内镜下不同方法治疗直肠神经内分泌肿瘤的疗效分析

目的 探讨内镜下不同方法治疗直肠神经内分泌肿瘤（NEN）的疗效。方法 回顾性分析2014年1月－2020年1月该院86例经肠镜白光及活检病理判断为直肠NEN患者的临床资料。其中,23例采用内镜下黏膜切除术（EMR）,49例采用内镜黏膜下剥离术（ESD）,14例采用内镜全层切除术（EFR）;记录并评估3组患者病灶大小、切除面积、术前超声深度、手术时间、病灶切除大小、住院时间、一次性整块切除率、一次性R0切除率、侧切缘及基底切缘阳性率、并发出血、穿孔发生率和3年生存率等情况。结果 EMR组、ESD组及EFR组病变切除面积中位数分别为100.00、240.00及320.00 mm2,呈明显递增趋势（P < 0.05）;手术时间分别为（20.04±6.44）、（46.35±8.76）和（54.21±7.65）min,明显延长（P < 0.05）;术后住院时间分别为（2.17±0.42）、（4.40±0.90）和（5.07±0.68）d,明显增加（P < 0.05）。而病变R0切除率、血管浸润率、淋巴管浸润率、神经侵犯率、垂直切缘阳性率、CD56表达率、嗜铬粒蛋白A（CgA）表达率和术后并发症发生率比较,差异均无统计学意义（P > 0.05）。结论 对于位于直肠的、无淋巴结转移的、直径小于10 mm的直肠NEN,可通过EMR、ESD及EFR安全切除。其中,EMR相对简单,手术时间明显短于ESD及EFR;EFR具有较高的整体切除率和组织学切除率,可能优于传统的EMR及ESD,但手术时间明显长于ESD和EMR,3种方法在R0切除率、术后并发症发生率及生存率上并无较大区别。     

Incidence and predictors of bleeding or thrombosis after polypectomy in patients receiving and not receiving anticoagulation therapy

Summary. Background and aims: To assess the effect of warfarin anticoagulation therapy (AC) on the incidence of colon bleeding after elective colonoscopy with polypectomy and to identify independent predictors of post‐polypectomy colon bleeding. Methods: This was a retrospective cohort analysis. Patients interrupting warfarin AC therapy for polypectomy (AC group) were matched on age (± 3 years) with up to two patients who underwent polypectomy but were not receiving AC (non‐AC group). Data were extracted from electronic medical, pharmacy and laboratory claims and records and manual medical chart review. Incidence rates of colon bleeding requiring hospitalization, other gastrointestinal bleeding, thrombosis and death in the 30 days post‐polypectomy were compared between groups. Multivariate regression techniques were used to identify independent predictors of post‐polypectomy colon bleeding. Results: A total of 425 AC group patients were matched to 800 non‐AC group patients. Post‐polypectomy colon bleeding occurred more often in AC group patients (2.6% vs. 0.2%, P = 0.005). There were no differences in the rates of other outcomes (P > 0.05). Independent predictors of colon bleeding included AC group status [adjusted odds ratio (AOR) = 11.6; 95% confidence interval (CI) = 2.3–57.3], number of polyps removed (AOR = 1.2; 95% CI = 1.1–1.4) and male gender (AOR = 9.2, 95% CI = 1.1–74.9). Conclusions: The incidence of post‐polypectomy colon bleeding was higher in patients receiving AC even although warfarin was interrupted for the procedure. Independent predictors of colon bleeding were identified as: receiving AC, removal of multiple polyps and male gender. Our findings suggest that additional methods to reduce the likelihood of post‐polypectomy colon bleeding in AC patients should be investigated.     

尼龙圈套扎后电切除结肠-直肠大息肉的体会

目的比较尼龙圈套扎和息肉基底部黏膜下层注射生理盐水溶液后再行高频电切除息肉并发症的发生率，探讨尼龙圈套扎治疗大息肉的临床应用价值。方法选择息肉直径≥2cm的长蒂粗蒂或亚蒂的宽基结肠-直肠大息肉28例，尼龙圈套扎组16例，息肉蒂基底部黏膜下层注射组12例，近期随访8例。结果16例尼龙圈套扎后电切组无并发症发生，12例黏膜下层注射后电切组1例患者术中出现即刻出血，1例术后（8h后）出现迟发出血。结论肠镜下行尼龙圈套扎后电凝电切除结肠-直肠大息肉操作简便，能有效地预防术中即刻出血和术后迟发出血，较黏膜下层注射更具有安全性。     

金属夹钳夹联合高频电凝切除术治疗消化道息肉的疗效分析

目的:探讨金属夹钳夹联合高频电凝切除治疗消化道息肉的疗效。方法:在内镜下应用金属夹钳夹联合高频电凝切除术治疗179例消化道息肉患者。术后内镜随访,评价治疗的安全性及有效性。结果:共成功切除216枚消化道息肉,息肉直径0.8～3.0cm,平均直径2.1 cm;成功切除率100%;无患者发生术中出血,1例(0.5%)患者发生术中穿孔;5例(2.7%)患者术后2周内发生迟发出血,再次内镜下治疗均成功止血。术后病理结果显示,腺瘤性息肉是最多见病变,其中2例为息肉癌变。术后随访中6例患者息肉残蒂存留,再次予以内镜下切除。结论:内镜下应用金属夹联合高频电凝切除消化道息肉能显著降低术后出血的风险。     

Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique

BACKGROUND AND STUDY AIMS: The endoscopic polypectomy of large pedunculated polyps can have serious complications, such as hemorrhage, which has an incidence of about 2 %. We describe here a new, safe, and effective technique of endoscopic polypectomy for the treatment of large pedunculated colorectal polyps using a standard detachable diathermic snare. PATIENTS AND METHODS: 35 patients (18 men, 12 women; mean age 67.3, range 35 - 82), with 43 pedunculated colorectal polyps, of benign appearance and of size 3 cm or larger (range 3 - 5 cm) on colonoscopy, were included in our study. The polypectomy was performed in two steps: a) we first placed a polypectomy snare round the middle of the stalk, as a prophylactic measure to prevent postpolypectomy bleeding, and we then took out the colonoscope without removing the snare after dismantling it and blocking with a clip; b) endoscopic polypectomy was done using a second polypectomy snare, and transecting the stalk of the polyps at 2 mm above the first snare. The first polypectomy snare was left in place, and the patients were discharged within 3 hours of endoscopic polypectomy. The first polypectomy snare sloughed off spontaneously and slipped down the anus, being evacuated within 4 days following the endoscopic polypectomy. RESULTS: The ensnared polyps were located in the rectosigmoid region (n = 27), and the descending (n = 13) and transverse colon (n = 3). Complete ensnarement of the head of the polyp with a single endoscopic treatment was obtained in all cases. In addition, no procedural or delayed bleeding was noted during a 6-month follow-up. CONCLUSIONS: Our technique allows us to overcome the risk of bleeding, since the use of a standard diathermic snare makes it easier to obtain optimal tightness. Moreover, this technique is cheaper than the use of the standard detachable snare currently available (the cost of the snares being $50.52 compared with $189.47).     

The Effect of Cold Therapy Applied to the Incision Area After Abdominal Surgery on Postoperative Pain and Analgesic Use

BackgroundCold therapy is one of the most common nonpharmacologic pain treatments. Despite the existence of many studies about cold therapy, few have examined the effects of cold therapy after abdominal surgery.AimsThe purpose of the study was to investigate the effect of cold therapy applied to the incision area after abdominal surgery on postoperative pain and analgesic use.DesignThis study was a randomized controlled trialMethodsThe sample included 60 patients (30 control, 30 experimental) undergoing abdominal surgery. Researchers recorded information from a patient information form, a visual analogue scale (VAS), a pain evaluation form, and the vital signs recording form.ResultsThere was no statistically significant difference in pain level between the experimental and control groups as measured by VAS at postoperative hour 1 (p > .05). Furthermore, no statistically significant difference in VAS pain levels between groups was observed at postoperative hours 1, 2, and 8 prior to application of cold therapy (p > .05). Then, when cold therapy was applied at hours 1, 2 and 8, the pain level decreased significantly in the experimental group (p =.001). Pain also decreased in the control group between hours 1 and 8, but this decrease was not as great as that in the experimental group (p = .024).ConclusionsBoth groups had decreased pain levels, and the decrease in the experimental group was greater than in the control group but cold therapy had no statistically significant effect on analgesics use.     

改良的圈套器行内镜黏膜下剥离术切除结直肠息肉及黏膜下肿瘤的疗效评价

目的探讨改良的圈套器行内镜黏膜下剥离术(ESD)切除结直肠息肉及黏膜下肿瘤的安全性、有效性。方法回顾性研究2014年12月-2016年5月利用改良的圈套器完成ESD切除结直肠息肉、神经内分泌肿瘤(NETs)和间质瘤患者的临床资料,探讨改良的圈套器进行ESD术治疗结直肠病变的安全性、有效性、治疗时间和并发症等,并与HOOK刀完成ESD术进行比较。结果共20例病例24处入选并完成ESD术,其中16例病例共20处病灶均顺利完成改良的圈套器行ESD术(实验组),4例病灶采用传统HOOK刀完成ESD术(对照组)。两组手术成功率均为100.0%,病灶整块切除率100.0%(24/24);实验组息肉长径为1.2~4.0 cm,平均长径(2.4±0.9)cm,对照组息肉长径为1.5~3.0 cm,平均长径(2.2±0.6)cm;实验组手术时间为45.0~120.0 min,平均时间(83.3±23.9)min,对照组手术时间45.0~80.0 min,平均时间(66.2±15.4)min,与对照组比较,实验组耗时长,差异具有统计学意义(P=0.038)。术后病理:结直肠腺瘤15例(其中3例腺瘤伴局部腺体高级别上皮内瘤变),增生性息肉1例,高级别上皮内瘤变1例,NETs 2例共4处病灶,间质瘤1例,两组中除1例来源于固有肌层间质瘤全层切除术以外,无1例出现出血、穿孔、感染等并发症,无1例术中、术后转外科治疗。结论改良的单圈套器能够安全、有效地完成ESD术切除巨大结直肠息肉及黏膜下肿瘤,拓展了圈套器在内镜切除术中的使用方法及适应证,但需要更长时间来完成手术。     

Detachable snare versus epinephrine injection in the prevention of postpolypectomy bleeding: a randomized and controlled study

BACKGROUND AND STUDY AIMS: Several endoscopic techniques have been developed to prevent bleeding after the removal of large pedunculated polyps. PATIENTS AND METHODS: From January 1995 to December 2002, 488 consecutive patients with pedunculated colorectal polyps, the heads of which were larger than 10 mm in diameter, were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used for polypectomy. In group B (161 patients), the polyp stalk was injected with a 0.01 % epinephrine solution before conventional snare polypectomy. Group C (a control group including 164 patients) underwent conventional snare polypectomy without preventive measures. Early (< 24 h) and late (> 24 h - 30 days) bleeding complications were assessed. Each group was divided into two subgroups relative to the polyp size (polyps 1.0 - 1.9 cm and polyps > or = 2 cm). RESULTS: Overall bleeding complications occurred after 4.3 % of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8 %), five in group B (3.1 %), and 13 in group C (7.9 %). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps > or = 2 cm (207 patients), postpolypectomy bleeding occurred in 14 patients (6.7 %): two (2.7 %) in the detachable snare group, two (2.9 %) in the epinephrine injection group, and 10 (15.1 %) in the control group. CONCLUSIONS: These results show that polypectomy of large pedunculated polyps is associated with a higher incidence of bleeding. Particularly in polyps larger than 2 cm, preventive measures can significantly reduce bleeding complications after polypectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.     

结肠镜辅助腹腔镜下直肠息肉切除术治疗直肠息肉的效果

目的探讨结肠镜辅助腹腔镜下直肠息肉切除术治疗直肠息肉的临床效果。方法将我院收治的60例直肠息肉患者根据手术方法不同分为对照组和观察组,各30例。对照组行结肠镜直肠息肉切除术,观察组行结肠镜与腹腔镜下直肠息肉切除术。比较两组的临床效果。结果两组术后第1、3、5天的VAS评分及术中出血量比较,差异不显著(P>0.05)。观察组的手术时间、肛门排气时间、进食恢复时间、住院时间均显著短于对照组(P<0.05)。观察组的并发症总发生率显著低于对照组(P<0.05)。结论在直肠息肉的临床治疗中,给予结肠镜辅助腹腔镜下直肠息肉切除术有助于促进患者的术后恢复,具备临床推广价值。