内境下高频电凝电切术治疗大肠息肉

大肠息肉是一种常见病，且有恶变倾向，大肠癌多数是由大肠息肉恶变而来，大肠息肉不论大小、部位及病理分型均有恶变的可能，因此发现息肉应及早摘除，以改善临床症状，降低大肠癌的发病率。我院自2000年1月至2004年6月应用电子结肠境下高频电凝电切术治疗大肠息肉96例，取得满意疗效，现报告如下：     

单人操作结肠镜治疗大肠息肉126例分析

近年我们应用结肠镜单人操作法，采用射频和高频电凝电切摘除术治疗大肠息肉126例，一次性治愈率高，并发症少，效果满意，现报告如下。     

大肠腺瘤26例癌变因素分析

1989年3月～1995年7月．我们共行结肠镜检查1870例，检出大肠脉瘤340例，占18％，其中癌变26例，占76％，现就大肠腺癌癌变的因素分析如下。1临床资料1．1一般情况本组26例中，男22例，女4例；年龄30～68岁，临床表现：便血21例，腹泻5例。1．2息肉切除采用奥林巴斯UES-10型高频电流发生器。首先常规插入结肠镜，发现息肉后，充分确认其位置、大小、形态后，反复冲洗，吸尽息肉表面粘液及周围液体。选择合适的电切圈套器，在内镜在视下，将息肉套入圈套器内，于息肉根部，逐渐拉紧套圈后，使用高频电凝、电切，直至息肉切除，仔细观察确认…     

363例大肠息肉的临床分析

目的探讨大肠息肉的有效诊治方法。方法对本院结肠镜检查诊断大肠息肉后并采用氩气高频电凝电切治疗的病例资料进行回顾性分析。结果内镜发现大肠息肉363例（其中确诊腺瘤样息肉恶变5例）,内镜下息肉切除330例,术后发生局部出血16例,通过内镜下治疗均有效控制。结论结肠镜检查及内镜下治疗大肠息肉是临床上一种有效、简单、安全的方法。     

大肠息肉182例临床与内镜分析

目的　总结大肠息肉诊断治疗经验 ,探讨症状与息肉部位、大小、组织学类型、患者年龄之间的关系。方法　对1 82例大肠息肉患者的诊疗情况进行回顾性分析。结果　青少年组主要症状为便血 ,中老年组主要症状为腹痛、腹泻 ,便秘集中于中老年组 ,未发现症状与息肉大小、类型、部位有关。 81例患者行镜下高频电息肉切除术 ,治愈 73例 ,好转 5例 ,无效 2例 ,术后肠穿孔 1例。结论　大肠息肉症状与患者年龄有相关性 ,而与息肉的部位、大小、组织学类型无明确的关系。镜下高频电凝切术是治疗大肠息肉的有效、安全的首选措施。     

结肠镜下粘膜下注射并高频电切息肉159例分析

目的:探讨电子结肠镜下粘膜下注射并高频电刀切除大肠息肉的疗效.方法:对159例266枚大肠息肉经电子结肠镜下粘膜下注射并高频电刀治疗进行总结.结果:全部病例均镜下完全切除,未发生严重并发症.结论:经结肠镜黏膜下注射并高频电切治疗息肉,可有效预防出血或穿孔并发症,使高频电切除术的安全性得以提高,同时也提高了息肉摘除术的成功率,是治疗结肠息肉的有效手段.     

消化道巨大息肉两种治疗方法疗效比较

1999年 1月～ 2 0 0 2年 3月 ,我们在内镜下发现消化道息肉共 79例 98枚。将直径 <3 0ｃｍ的息肉均采用高频电切 +电凝摘除法或单纯高频电凝摘除法 (以下简称电切组 ) ,将≥ 3 0ｃｍ的息肉均采用尼龙圈套扎 +高频电切除法 (以下简称套扎组 ) ,以比较两种治疗方法的疗效。1　对象和方法1 1　对象　电切组 5 5例 70枚 ,套扎组 2 4例 2 8枚。两组性别、年龄、息肉部位基本相同 ,具有可比性。电切组有蒂息肉 2 8枚 ,亚蒂息肉 11枚 ;套扎组有蒂息肉 2 0枚 ,亚蒂息肉 8枚。所有病例均在术前经内镜检查及病理活检确诊无癌变。1 2　方法　消化内镜 :…     

内镜下结肠息肉切除应用钛夹预防迟发性出血临床观察

目的：探讨金属钛夹在结肠息肉高频电切除术中的应用效果。方法：2011年2—2013年6月收治的31例结肠息肉患者应用钛夹结合电凝电切术切除结肠息肉,观察患者的术中、术后出血等并发症情况。结果：患者手术过程均顺利,1例息肉较大,蒂粗的息肉电切后有少许渗血,应用4枚钛夹后残基无出血。余患者无术后迟发性出血及穿孔。结论：在内镜下电切结肠息肉的治疗中,金属钛夹可以起到迅速止血和预防再出血、穿孔等并发症的发生。     

纤维结肠镜高频电凝切大肠息肉66例

息肉为大肠疾病中的常见病之一,常见的临床症状是便血,其危险性是可恶变,因此,应及早发现,予以摘除.经纤维结肠镜高频电凝切除大肠息肉,可以避免外科手术,并可提供病理组织学的分类研究.我院自1982年以来在纤维结肠镜下高频电凝切大肠息肉66例,共摘除109个息肉,现报告如下.一般资料66例中单发息肉47例,多发息肉19例.男性51例,女性15例,男:女=3.4:1.年龄6～70岁,以20～30岁组最多,共20例(30.3%),41～50岁和51～60岁组分别为15例(22.7%)和14例(21.2%),居2、3位.病程1个月～5     

内镜下高频电摘除大肠息肉87例报告

内镜下高频电摘除大肠息肉是应用电热法将息肉凝固、止血并切除.因其安全有效,得到了广泛应用.我院胃镜室自1982年9月～1993年6月应用本法摘除大肠息肉87例201颗,收到良好效果,现报告下.一、资料和方法1.治疗对象:本组共87例,男67例,女20例,年龄11～74岁,平均48岁.87例患者息肉201颗,其中直肠息肉74颗,乙状结肠息肉67     

Straightening the colon with curved cross sections: An approach to CT colonography

RATIONALE AND OBJECTIVES: The purpose of this study was to straighten digitally and consistently the colon with curved cross sections and to compare the results with planar cross-section-based processing for computed tomographic (CT) colonography. MATERIALS AND METHODS: In electric field-based straightening, curved cross sections are formed along electric force lines because of electric charges digitally distributed along the colon central path. Four straightening experiments were conducted on CT scans of a colonoscopy phantom. Representative images were studied for polyp detectability and feature distortion. Two further trials involved patient data to demonstrate the clinical feasibility of this method. RESULTS: In colon straightening with planar sections, a polyp was counted multiple times in both phantom and patient studies where the polyps were in central path turns with substantial curvature. Furthermore, opposite the central path turns, the colon walls were undersampled with planar sections. Straightening with curved sections produced consistent mappings. Image distortion was present in straightening with curved sections, but the conspicuity of polyps was maintained. In the soft-straightening process, trilinear interpolation greatly suppressed the surface- or volume-rendering noise associated with nearest neighbor interpolation. CONCLUSION: Straightening with curved sections outperforms straightening with planar sections in terms of polyp detectability. This approach eliminates the navigation difficulties of current CT colonography and may have clinical use.     

550例大肠息肉的临床病理分析、内镜下治疗及随访

本文报道５５０ 例大肠息肉的临床及病理特点、内镜下治疗及１～２０ 年随访结果。大肠息肉的检出率为１４．０％ ，５０ 岁以上患者占 ４９．１％ ，单发性息肉 ４２０ 例，多发性息肉 １３０ 例，好发部位为乙状结肠和直肠（５０．５％ ）。病理诊断以腺瘤性息肉（４２．２％ ）和炎性息肉（４０．０４％ ）最多，息肉的异型增生发生率为１４．２％ ，腺瘤性息肉的癌变率为 １２．１％ ，结肠癌伴息肉的发生率为 ２．９％ 。对５４４ 例患者进行了内镜下息肉治疗，息肉的复发及再发率为５５．４％ ，平均复发时间为 ３２ 个月。随访检出４ 例息肉癌变，分别在术后第 ３、５、１０、２０ 年。     

Konventionelle Kolonoskopie

In the last 40 years colonoscopy has been the gold standard in diagnosis of conditions affecting the large intestine. We see its main disadvantages in the necessity for intestinal preparation and in the pain not infrequently experienced by patients who are not sedated. Widespread use of sedation has made it possible to improve patient acceptance in recent years. Complications of colonoscopy are rare, and even the removal of large polyps is regarded as a safe procedure. One of the main problems of colonoscopy is that a large number of far from trivial polyps - up to 20% in the literature - are overlooked. New developments, such as higher resolution videochips and chromoendoscopy, lead to a better diagnostic yield, especially of flat lesions. The rapidly developing sector of interventional colonoscopy in particular will ensure that colonoscopy continues to have an important place in the management of illnesses affecting the large intestine.     

应用Nd:YAG激光治疗大肠息肉50例体会

本文总结了50例大肠息肉应用低功率Nd：YAG激光治疗获得满意效果的经验和体会。经追踪复查，50例患者术中术后无一例并发症；1～12个月后复查原息肉部位肠粘膜平整光滑，血管网清晰，残根消失，无瘢痕形成。我们认为：保持清晰的视野，选择合适的激光功率，掌握好光纤角度和保证照射部位准确，是安全彻底治疗肠道息肉的关键。     

内镜下橡皮圈套扎术在上消化道广基息肉切除术中的应用

目的探讨橡皮圈套扎术在上消化道广基息肉切除术中的应用。方法回顾分析54例术前病理证实为良性病变的上消化道广基息肉,其中采用橡皮圈套扎术24例,为橡皮圈组,对照组30例单纯采用高频电凝电切术治疗。比较两组的术后出血发生率、穿孔率。结果所有患者均成功切除息肉,橡皮圈组无穿孔及出血发生,3 d后复查胃镜示息肉已脱落,溃疡形成。对照组有1例穿孔,5例早期出血,2例迟发性出血,均予钛夹钳夹创面后出血停止。两组比较,早期出血发生率有统计学差异(P<0.05),而迟发性出血发生率及穿孔率均无统计学差异(P>0.05)。结论橡皮圈套扎治疗广基息肉是一种安全有效的方法,能有效地避免早期出血等并发症。     

大肠癌患者血清脂蛋白、血脂、癌胚抗原分析

目的：观察大肠癌患者术前术后血清脂白、血脂、癌胚抗原的变化。方法：对４６例大肠癌病人和４０例正常人检测血清ＴＣ、ＴＧ、ＨＤＬ－Ｃ、ＬＤＬ－Ｃ、ＣＥＡ术前术后的改变。结果：术前大肠癌血清ＴＣ和ＨＤＬ－Ｃ水平明显低于正常组,ＣＥＡ水平明显高于正常组,差异非常显著（Ｐ〈０．０１）;术后大肠癌血清ＴＣ、ＨＤＬ－Ｃ、ＣＥＡ水平与正常组对照有显著差异（Ｐ〈０．０５）,大肠癌恶性程度高则血清ＴＣ和ＨＤＬ－Ｃ水平     

氩离子凝固术治疗结直肠息肉的临床应用价值

目的探讨氩离子凝固术治疗结直肠息肉的疗效及临床应用价值。方法对160例患者共351枚结直肠息肉行氩离子凝固术(APC)治疗,其中214枚扁平和65枚亚蒂息肉仅行APC治疗,72枚有蒂息肉电切治疗后用APC处理息肉残端。结果本组病例全部临床治愈。2例患者出现无症状的局部黏膜下气肿,78例患者出现短暂腹痛,未行处理自行缓解。结论 APC是一种安全有效的结直肠息肉治疗方法,副反应少,操作简便,尤其是在扁平、广基息肉的治疗中可作为首选方法。     

Colonic polyps: complementary role of computer-aided detection in CT colonography

PURPOSE: To apply a computer-aided detection (CAD) algorithm to supine and prone multisection helical computed tomographic (CT) colonographic images to confirm if there is any added benefit provided by CAD over that of standard clinical interpretation. MATERIALS AND METHODS: CT colonography (with patients in both supine and prone positions) was performed with a multisection helical CT scanner in 40 asymptomatic high-risk patients. There were two consecutive series of patients, 20 of whom had at least one polyp 1.0 cm in size or larger and 20 of whom had normal colons at conventional colonoscopy performed the same day. The CT colonographic images were interpreted with an automated CAD algorithm and by two radiologists who were blinded to colonoscopy findings. RESULTS: For 25 polyps at least 1.0 cm in size ("large" polyps), sensitivity for detection by at least one radiologist was 48% (12 of 25). The sensitivity of CAD for detecting large polyps was also 48% (12 of 25), but the CAD algorithm detected four of 13 large polyps that were not detected by either radiologist (31%, 95% two-sided CI: 9, 61), increasing the potential sensitivity to 64% (16 of 25). For polyps identifiable retrospectively, sensitivity of CAD was 67% (12 of 18), and sensitivity of the combination of detection with the CAD algorithm or by at least one radiologist was 89% (16 of 18). There were an average of 11 false-positive detections per patient for CAD. CONCLUSION: In this series of patients in whom radiologists had difficulties detecting polyps (compared with sensitivities of 75%-90% reported in the literature), this CAD algorithm played a complementary role to conventional interpretation of CT colonographic images by detecting a number of large polyps missed by trained observers.     

Polyp detection with MDCT: a phantom-based evaluation of the impact of dose and spatial resolution

OBJECTIVE: The objective of our study was to evaluate the impact of dose and spatial resolution on the detection of colonic polyps using a 4-MDCT scanner. MATERIALS AND METHODS: Twenty-four latex phantoms that simulate the large bowel and contain artificial polyps of different sizes and shapes were constructed. The polyps were divided into three size groups (diameter, 0-2, 2-5, and 5-10 mm) and were classified into four shape groups: pedunculated; broad-based; ulcerated or depressed; and sessile or flat. The colon phantoms were submerged in a water tank and scanned on a 4-MDCT scanner using 12 protocols with various settings of slice thickness, pitch, and tube current. The images were independently evaluated by three radiologists using axial 2D multiplanar reconstruction images and a 3D surface-rendering technique (fly-through). RESULTS: At a constant dose (i.e., dose-length product [DLP]), the polyp detection rate increased with increasing axial spatial resolution. For the standard protocol (2.50-mm slice thickness, 1.5 pitch), the detection rate for all polyp sizes decreased from approximately 70% at 100 mA to 55% at 40 mA. Between a 60- and 100-mA tube current, the detection rate for the largest polyps (> 5 mm) was almost constant, close to 90%. CONCLUSION: The detection of polyps in the large bowel using a standard protocol can be improved without dose penalty by increasing the axial spatial resolution of the image acquisition and adjusting the tube current setting. If the analysis can be restricted to polyps larger than 5 mm, the dose can be substantially reduced without compromising the detection rate.