夹闭创面预防结肠无蒂息肉切除术后迟发性出血的meta分析

目的 预防性夹闭创面对息肉切除术后迟发性出血(DPPB)的效果存在争议,因包括息肉大小、形态、位置等因素的影响,既往的荟萃分析得出的结论有限.评估预防性夹闭创面对无蒂息肉切除术后DPPD的影响.方法 在Pubmed、Embase、Cochrane数据库检索建库至2020年8月31日发表的,关于预防性夹闭创面预防息肉切除...     

留置金属夹预防结肠小息肉内镜黏膜切除术后迟发性出血的价值研究

目的探讨直径10 mm以下无蒂结直肠息肉行内镜黏膜切除术（endoscopic mucosal resection, EMR）后,留置金属夹对于预防息肉切除术后迟发性出血（delayed post-polypectomy bleeding,DPPB）的价值。方法将2017年1月—2019年12月于黑龙江省医院消化病院因直径10 mm以下无蒂结直肠息肉拟行EMR的患者,根据计算机产生的随机序列表分为术后留置金属夹组(A组)和未留置金属夹组（B组）,对比两组术后迟发性出血的相关情况。结果共纳入1 838例患者,A组912例,B组926例。两组术后迟发性出血发生率分别为1.00%（9/912）和1.10%（10/926）,组间差异无统计学意义（χ2=0.039,P＞0.05）。两组出血息肉个数比例为 0.44%（9/2 029）和0.49%（10/2 025）,组间差异无统计学意义（χ2=0.055,P>0.05）。6~9 mm息肉（OR=11.032,95%CI：2.545~47.821,P＜0.05）是无蒂结直肠息肉EMR术后迟发性出血的独立危险因素。结论10 mm以下无蒂结直肠息肉EMR治疗后,留置金属夹并未显著降低术后迟发性出血的风险。     

改良黏膜刀辅助切除术治疗结直肠粗蒂大息肉的初步研究

目的 探讨改良黏膜刀辅助息肉切除术(KAP)治疗结直肠粗蒂大息肉的安全性和有效性。方法 我们在既往其他学者的研究基础上,对KAP技术做出如下改良：首先采用放大内镜对结直肠粗蒂大息肉头端及根部进行JNET与Pit pattern分型,评估病变性质,排除恶性息肉;然后使用止血夹夹闭息肉根部阻断血流;再使用HOOK刀或IT刀沿止血夹上方1～2 mm处将息肉整块切除;止血钳、钛夹或(和)尼龙绳进一步处理创面;取出标本、固定送检病理。在此基础上,回顾性分析2019年1月至2022年10月在连云港市第二人民医院内镜中心行改良KAP治疗的15例结直肠粗蒂息肉患者的临床资料,统计手术切除操作时间和术后并发症发生情况等,初步分析改良KAP的治疗效果。结果 手术中无大出血以及穿孔发生,术后未出现迟发性出血,也未出现迟发性穿孔和电凝综合征。术后病理显示完整切除率为100%。结论 改良KAP治疗结直肠粗蒂大息肉操作安全有效。     

金属夹联合尼龙套圈在内镜带蒂大息肉摘除中的应用

背景：消化道出血是内镜息肉摘除术最常见的并发症。目的：观察金属夹联合尼龙套圈对内镜带蒂大息肉摘除术的效果和安全性。方法：选取2011年6月一2012年8月上海市第一人民医院分院89例带蒂大息肉患者,分为尼龙套圈组（A组）和金属夹联合尼龙圈套组（B组）,回顾性分析息肉形态、部位、大小以及并发症发生率。结果：A组和B组息肉形态均以山田Ⅳ型为主,主要位于乙状结肠,两组患者性别、年龄、息肉顶部、蒂部平均直径相比均无明显差异（P〉0．05）。A组和B组的术中出血发生率（12．8％对10．0％）、术后迟发性出血发生率（10．3％对4．0％）相比均无明显差异（P〉0．05）,经治疗后出血均停止。A组2例患者术后3个月息肉复发,B组手术创面愈合良好,无息肉残端残留。结论：金属夹联合尼龙套圈能有效预防内镜下带蒂大息肉切除术中和术后的出血。     

尼龙圈套扎防治大肠息肉摘除时的出血

为了减少或避免大肠粗大息肉电凝摘除时的出血，我院对大于２ｃｍ的大肠息肉，采用单纯尼龙圈套扎或尼龙圈套扎与电凝摘除联合应用的方法，１０例１２颗息肉全部取得成功，现初步报告如下。一、材料和方法１９９５年７月至１９９６年６月，我们在大肠镜下发现直径２～３．...     

内镜下金属夹治疗和预防消化道出血的临床应用

目的验证内镜金属夹治疗和预防消化道出血的效果。方法选用Olympus可旋式放置器HX-5QR-1和MH858,MD850型内镜金属夹;夹与靶之间的角度为90度。结果43例中21例消化道出血病例中即时止血成功率为100%,一周内再出血发生率为4.76%;22例息肉切除后应用金属夹可避免出血、人工溃疡形成和穿孔。结论内镜金属夹治疗和预防消化道出血疗效满意、安全易行。     

金属夹钳夹预防和治疗消化性息肉切除出血

内镜下对消化性息肉圈套电凝切除术时,往往因电凝不充分或机械性切割很容易造成术中即刻出血或术后迟发性出血等并发症。为了预防该并发症,我院对２１例２２枚消化性息肉,采用ＭＤ－８５０型和ＭＨ－８５８型金属夹钳夹与电凝切除联合应用,收到较好疗效。     

内镜下黏膜切除术治疗结肠扁平息肉术后出血的风险评估模型构建及验证

目的 构建内镜下黏膜切除术（EMR）治疗结肠扁平息肉术后出血的风险评估模型,并予以验证。方法 回顾性分析2021年4月至2021年12月汕头市潮阳区大峰医院收治的244例结肠扁平息肉患者的临床资料,患者均行EMR,根据EMR术后7 d内出血与否将患者分为未出血组（224例）和出血组（20例）。采用多因素logistic回归模型分析结肠扁平息肉患者EMR术后出血的影响因素,并根据上述各独立危险因素的回归系数构建风险评估模型,采用Hosmer-Lemeshow(H-L)检验和ROC曲线验证该模型的效能。结果 单因素分析结果显示,出血组中有长期吸烟史者、钛夹稀疏者、术中出血量≥50 mL者的占比,以及最大基底直径、切除数量均显著高于未出血组（P均<0.05）。多因素logistic回归模型分析结果显示,长期吸烟史、钛夹稀疏、术中出血量≥50 mL、最大基底直径均是结肠扁平息肉患者EMR术后出血的独立危险因素（P均<0.05）;以上述4项独立危险因素构建风险评估模型,该模型的ROC曲线下面积（AUC）为0.720(95%CI:0.631～0.797),H-L检验结果为0.095。该...     

内镜下套扎及电凝切除术治疗消化道广基息肉

目的探讨内镜下采用尼龙圈套扎和联合电凝电切除消化道广基息肉的临床疗效。方法 82例消化道广基息肉患者,随机分为两组,治疗组通过内镜下尼龙圈套扎联合电凝切除息肉,对照组行单纯内镜下电凝切除息肉,观察并随访其术后疗效。结果治疗组一次性治疗成功率为98.1%,对照组为88.4%。结论对于消化道广基息肉内镜下尼龙圈套扎联合电凝治疗成功率高,并发症少,安全有效,值得临床推广。     

经内镜金属夹钳夹后电凝切除治疗胃肠宽蒂大息肉

内镜下高频电凝切除术治疗胃肠道息肉最常见的并发症是出血和穿孔,直径>2cm尤其是蒂基部直径>1cm者,因电凝不充分或机械性切割,易产生即时或术后出血,甚至穿孔。金属夹因其牢固的钳夹作用,已成为内镜下治疗多种消化道出血的首选方法,我们利用其良好的止血特性对25例胃肠宽蒂大息肉先行钳夹,然后电凝切除,取得了良好的疗效。     

内镜下尼龙绳套扎治疗大肠息肉

目的 探讨内镜下尼龙绳套扎法治疗宽基底或粗蒂的大肠息肉的价值。方法 将尼龙绳圈通过肠镜操纵把手套扎于息肉根部。结果 本组32例共40枚大肠宽基底或粗蒂息肉均一次性套扎成功，11枚同时加高频电切除。术后2周复查示30枚息肉完全脱落消失(含已用切除者)，6枚部分脱落，治愈率、有效率、无效率分别为78．9％、15．8％、5．3％。所有病例未见出血、穿孔等并发症。结论 尼龙绳套扎法对宽基底或粗蒂的大肠息肉治疗效果满意，并发症少。     

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.     

大肠息肉电切前活检与电切后的临床病理比较

目的　比较大肠息肉电切前活检与电切后息肉组织的临床病理状况。方法　回顾 5年间在我院接受大肠息肉电切的病例 ,对比分析每一病例电切前、后的临床报告及病理诊断 ,要求 :①电切前后的病理来源于同一息肉 ;②对多次电切病例只取第一次进入病例分析 ;③多发息肉患者取第一枚电切息肉入组 ,其余排除 ;④去除电切前活检已有癌变的病例。结果　在 2 2 0例中符合要求的共 12 0例 ,年龄 5 9 8± 13 3岁 ,其中男性占 65 8% ;活检和电切病理诊断不符合率为 3 3 3 % (4 0 / 12 0 ) (P <0 0 1) ;活检和电切分别诊断腺瘤性息肉 88例 (73 3 % )和 10 0例 (83 3 % ) ,其中不典型增生分别有 2 9例 (3 3 0 % )和 46例 (4 6 0 % ) (P <0 1) ;电切后发现 5例腺瘤性息肉癌变 ,占 5 % (5 / 10 0 ) ,全部来源于 2 7例绒毛状腺瘤 (占其中 18 5 % ) ;活检诊为炎性的息肉和增生性息肉的病例 ,电切后分别有 60 % (15 / 2 5 )和 4/ 7被诊断为其它息肉类型 ;电切后发现活检未曾诊断的幼年性息肉 2例、间质瘤 2例、平滑肌瘤 1例 :绒毛状腺瘤的直径较大 ,为 1 43± 0 5 8cm ,其余各型息肉直径均在 1cm左右 ;癌变息肉直径最大 ,达 1 8± 0 5 7cm ,其最小直径是 1cm。结论　大肠息肉电切前后的临床病理存在较大差异 ,活检     

Management of patients with polyps containing malignancy removed by colonoscopic polypectomy

The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinomain situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy. Read at the meeting of the American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 5 to 9 1983.     

Management of massive postpolypectomy hemorrhage: Report of a technique

A case of massive rectal hemorrhage following colonoscopic polypectomy is reported. A simple technique to gain control of the bleeding using the “plumber's helper” (or polypectomy grasping forceps) is described. The literature is briefly reviewed.     

结直肠手术后吻合口出血诊治进展

结直肠手术术后吻合口出血是较为严重的并发症,如未给予正确、及时的处理,患者可能出现失血性休克甚至危及生命,因此应引起结直肠外科医师的重视。笔者针对结直肠手术后吻合口出血的发生率、危险因素、预防措施进行总结,并探讨了各种治疗方式的适应证及特点。