高频电切联合氩离子凝固术在治疗胃多发息肉中的应用

目的:探讨经内镜高频电切联合氩离子凝固术(argon plasma coagulation,APC)治疗胃多发息肉的实用价值.方法:分别用高频电切联合氩离子凝固术(A组)与高频电切联合电凝(B组)治疗胃多发息肉70例患者.分析比较两组患者的基本资料及治疗效果.结果:70例患者共356枚息肉,经高频电切联合氩离子凝固术36例(A组,182枚,其中山田Ⅰ-Ⅱ型151枚,山田Ⅲ-Ⅳ型31枚)均一次性顺利切(灼)除,经内镜高频电切联合电凝34例(B组,174枚,其中山田Ⅰ-Ⅱ型146枚,山田Ⅲ-Ⅳ型28枚)其中25例(145枚)息肉一次性顺利切(灼)除,另9例(29枚)出血需钛夹止血.A组治疗过程中止血效果明显优于B组(χ2 = 33.02,P<0.01).结论:经内镜高频电切联合氩离子凝固术效确切,操作简便、安全性好、不良反应少,耗时少,优于高频电切联合电凝治疗,有较高的临床推广价值.     

氩离子凝固术联合高频电切术治疗结直肠息肉102例

2003年7月～2006年2月,我们应用氩离子凝固术（APC技术）联合高频电切术治疗结直肠息肉102例,效果满意.现报告如下.     

内镜下氩离子凝固术治疗胃肠道多发性小息肉的护理

氩离子凝固术（Argon plasma coagulation,APC）作为一种新型非接触性内镜电凝固技术,因其具有操作简便、疗效确切、安全性高等优点,近年广为应用[1,2]。我院自2005年7月至2006年12月应用该技术治疗胃肠道多发性小息肉,效果明显。现将有关护理工作报告如下。[第一段]     

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。     

氩离子凝固术治疗消化道息肉20例

目的探讨内镜下氩离子凝固术（APC）对于消化道息肉的治疗作用。方法对20例患者85枚消化道息肉行内镜下APC治疗，氩气流量设定为2L／min，功率40～60w，治疗1周后复查。结果20例患者经1—4次治疗息肉均消失，治疗过程中及治疗后无明显的副作用。结论APC治疗消化道息肉安全、方便、快捷、有效。     

氩离子凝固术治疗消化道息肉的应用价值

目的探讨氩离子凝固术的临床应用价值,评估其安全性及疗效。方法对2004年1月至2006年1月在哈尔滨医科大学附属第二医院消化內镜诊疗中心就诊的70例消化道息肉患者,采用德国ERBE公司生产的APC300EA型内镜下专用氩气刀,对广基扁平息肉进行经内镜下氩离子凝固术(APC)根除治疗。其中,直径在0.2~0.8cm广基、扁平息肉仅行APC切除治疗,直径在1.0~2.0cm的细蒂或粗蒂及宽基底大息肉行高频电切局部创面渗血,再行APC止血治疗。结果本组病例全部临床治愈。其中,一次成功切除50余枚息肉2例,20余枚2例,10余枚3例,仅用圈套器一次成功切除结肠多发有蒂大息肉30余枚2例。术后仅有2例患者出现无症状的局部黏膜下气泡,1周后复查无其他并发症发生。结论APC结合高频电切在各种消化道息肉病变治疗中安全性好,可有效止血,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。     

氩离子凝固术治疗消化道出血和息肉的疗效及监护

目的 探讨内镜下氩离子凝固术(APC）治疗消化道出血及息肉的临床价值及护理体会。方法 采用德国ERBE公司生产的APC300型氩气刀对消化道出血及息肉进行氩离子凝固术，并对所有病人加强术前、术中、术后的护理。结果 14例上消化道出血病人经治疗后12例未再出血，2例病人再出血。34例消化道息肉病人经APC治疗全部治愈。结论 APC治疗消化道出血及息肉疗效确切、安全性好、副作用小，有较高的临床价值。通过加强对病人的护理，可减轻病人的精神负担，保证手术顺利，防止术后并发症的发生。     

肠镜下氩离子凝固术治疗大肠息肉78例护理体会

电子结肠镜下手术是治疗大肠息肉的首选方法,可用术式有微波凝固、高频电凝电切、氩离子凝固等疗效不一。2007年11月-2008年5月,我们共为78例大肠息肉患者施行电子结肠镜下氩离子凝固术,疗效满意。现将护理体会报告如下。     

尼龙圈套扎联合高频电切治疗胃肠道息肉

消化道息肉因可发生癌变和出血,发现后应予切除。为了提高内镜下切除息肉的安全性和治愈率,1999年以来,作者采用尼龙圈套扎联合高频电切治疗胃肠道息肉39例,取得了满意效果。     

氩离子凝固术治疗十二指肠息肉的临床研究

目的探讨应用氩离子凝固术(APC)治疗十二指肠息肉的疗效及安全性,并与微波治疗十二指肠息肉的效果进行比较研究。方法选择2008年12月至2013年2月经胃镜检查确诊的151例十二指肠息肉患者按治疗方式随机分为两组:APC组75例,微波治疗组76例。观察比较两组患者的息肉根除率、并发症、治疗疗程及费用。结果(1)APC组和微波治疗组的息肉根除率分别为90.6%、66.9%,差异有非常显著性(P0.01);(2)APC组治疗期间有8例出现轻度的并发症,给予对症处理后消失,微波治疗组有18例出现糜烂,7例出现上消化道出血,对症治疗后痊愈;(3)两组患者住院时间比较无统计学差异(P0.05),微波治疗组住院费用高于APC组(P0.05)。结论氩离子凝固术治疗十二指肠息肉效果明显,副作用小,安全可靠,值得临床推广应用。     

氩等离子体凝固在食管癌支架置入后的临床应用

目的：探讨内镜下氩等离子体凝固(APC)在食管癌金属支架置入后的临床应用。方法：对10例食管癌镍钛合金支架置入后新生物过度生长者，应用APC治疗。结果：9例患者治疗后的评价均为有效，症状明显改善，术后3～8个月复查局部没有肿瘤组织再生，支架无断裂。结论：经内镜APC治疗是解决肿瘤组织向支架内过分生长的有效手段之一。     

内镜下氩离子凝固术治疗疣状胃炎56例的疗效观察

目的探讨氩离子凝固术对疣状胃炎的治疗效果.方法在内镜直视下,采用氩离子凝固器,经内镜钳道插入氩气电凝导管,直至病灶上方0.3～0.5 cm处,以每次1～3 s的时间对疣状胃炎进行氩离子凝固术治疗.结果56例疣状胃炎患者临床症状明显改善,内镜复查病灶消失.结论氩离子凝固术治疗疗疣状胃炎是一种疗效确切,安全性好,副作用少的方法.     

经内镜氩离子凝固术治疗隆起糜烂性胃炎的研究

目的　研究应用氩离子凝固术(argonplasmacoagulator,APC)治疗隆起糜烂性胃炎的价值及安全性。方法　将 66例隆起糜烂性胃炎患者随机分成A组(先药物后APC治疗组)和B组(药物+APC同时治疗组 ),比较两种方法的疗效。结果　66例患者 51例幽门螺杆菌(Hp)阳性, 36 4% (24 /66)的患者发现肠上皮化生。在A组,单纯药物治疗仅有 15 6% (5 /32 )的患者隆起糜烂性病变消失,而应用APC治疗后, 92 6% (25 /27)的患者隆起糜烂病变消失;在B组,隆起糜烂病变治愈率达 91 2% (31 /34 ),与单纯药物治疗比较差异具极显著性(P<0 01)。APC治疗后仅 1例出现黏膜下气肿,且在 2周后自动吸收。7例出现轻微上腹胀或上腹隐痛,但均在术后 3~7d消失。61例患者共进行了 69次APC治疗,共治疗隆起糜烂性病变 352个,平均每次治疗用时为 11min。结论　隆起糜烂性胃炎的发病与Hp感染有关,容易发生肠上皮化生。单纯药物治疗疗效欠佳。APC治疗隆起糜烂性胃炎不仅疗效显著,而且安全简便。     

氩离子凝固术治疗胃黏膜脱垂症的临床研究

目的 探讨应用氩离子凝固术(APC)治疗胃黏膜脱垂症的疗效及安全性,并与微波治疗胃黏膜脱垂症的效果进行比较研究.方法 选择2008年12月至2010年10月经胃镜检查确诊的140例胃黏膜脱垂症患者,按治疗方式随机分为两组:APC组69例,微波治疗组71例.观察比较两组患者的有效率、并发症、治疗疗程及费用.结果 (1)...     

Effect of Antithrombotic Therapy on Bleeding after Argon Plasma Coagulation for Gastric Neoplasms

Background/AimsPostprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors.MethodsA total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC.ResultsOf the total 821 cases, DB occurred in 20 cases (2.4%) 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents.ConclusionsAT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding.     

内镜下氩离子凝固术治疗消化道病变的临床应用

目的探讨氩离子凝固术(APC)在消化道病变内镜介入治疗中的临床应用。方法2005年3月～2009年3月,采用内镜下APC单独或联合治疗509例消化道病变患者,并观察其治疗效果。结果353例胃肠道广基、扁平息肉及息肉残迹经APC治疗后3个月内复查内镜,黏膜色泽正常,原治疗部位无复发。68例成熟型疣状胃炎患者治疗后1月临床症状明显改善,内镜复查病灶好转或消失。17例Barrett食管患者6个月后内镜及病理检查示14例恢复为鳞状上皮,12个月后复查未见复发。38例消化道出血经APC治疗后均未再出血。12例食管支架植入术后再狭窄晚期食管癌患者经APC治疗后实现再通。15例食管中重度不典型增生患者经APC治疗病灶消除。6例联合黏膜切除术早期癌患者治愈。均无严重并发症。结论APC在消化道病变内镜介入治疗中效果显著,且简便易行,并发症少,有较高的临床应用价值。     

氩离子凝固术加抑酸逆转Barrett's食管上皮的临床研究

目的观察氩离子凝固术(APC)加抑酸治疗对Barrett’s食管上皮的逆转作用。方法对45例以内镜和病理确诊的Barrett’s食管病人,随机分为治疗组与对照组,治疗组采用氩离子凝固加质子泵抑制剂(APC)组,对照组采用传统质子泵抑制剂治疗(PPI组)。于治疗后第3个月和第6个月进行内镜及病理复查,观察2组Barrett’s食管上皮逆转情况。结果APC组23例Barrett’s食管上皮逆转总有效率在第3、6个月时分别为69.6%和82.6%,而对照组(PPI组)分别为9.5%和22.2%。无出血、穿孔等严重并发症。结论氩离子凝固术结合抑酸治疗能有效逆转Barrett’s食管上皮,大多数患者出现鳞状上皮再生,但不排除在新生的鳞状上皮下有残留的肠上皮化生及复发的可能,需长期随诊。     

Hyperplastic Polyps of the Gastric Antrum in Patients with Gastrointestinal Blood Loss

The significance of hyperplastic polyps of the gastric antrum in anemic patients with suspected gastrointestinal bleeding has not been determined. The aim of this study is to evaluate the prevalence and prognosis of such polyps in this patient group. Clinical records of patients referred to our endoscopy lab from November 1999 to February 2003 for the evaluation of iron deficiency anemia or suspected gastrointestinal bleeding were reviewed. There were 987 patients. Fourteen patients (1.4%) had hyperplastic polyps in the gastric antrum. Five of the patients reported melena, but the rest were asymptomatic. Multiple antral polyps were present in seven cases. The largest polyp measured 5.0 cm. Helicobacter pylori infection was present in one patient. All patients were anemic and nine had documented iron deficiency. No follow-up information was available in four patients. Hyperplastic polyps of the gastric antrum are a rare but significant cause of gastrointestinal blood loss in older patients. Removal of the polyps using endoscopic or surgical methods may be required for resolution of the blood loss along with iron supplementation. Gastroenterologists should be aware that hyperplastic polyps of the gastric antrum might result in gastrointestinal blood loss and iron deficiency anemia.     

Long-Term Outcome of Argon Plasma Ablation Therapy for Bleeding in 100 Consecutive Patients with Colonic Angiodysplasia

Purpose Angiodysplasia is a frequent cause of colonic bleeding. Argon plasma coagulation was reported to be useful in endoscopic hemostasis. However, the long-term outcomes have been poorly evaluated. This study was designed to assess the long-term outcomes of bleeding patients with colonic angiodysplasia treated by argon plasma coagulation. Methods A cohort of 100 patients with gastrointestinal bleeding caused by colonic angiodysplasia was studied prospectively. The endoscopic intervention was considered successful if there was no further overt bleeding and hemoglobin concentration was stabilized (primary end point). Secondary end points were the requirement of blood transfusions, the need for surgery, bleeding-related mortality, and overall mortality. Results Overt bleeding resolved and hemoglobin levels were stabilized without transfusions or iron therapy in 85 of 100 patients (85 percent) after a median follow-up of 20 (range, 6-62) months. Transfusion requirements ceased in 90 percent of patients and only one required surgery. No patient died because of hemorrhage. In the subgroup of patients with anemia, mean hemoglobin levels increased from 9.3 (range, 5.5–12.2) g/dl before treatment to 12.6 (range, 7.4–16.7) g/dl after treatment (P < 0.01). The probability of remaining free of rebleeding at one and two year follow-up was 98 percent (95 percent confidence interval, 96–100) and 90 percent (95 percent confidence interval, 83–97), respectively. Among 118 procedures, only two complications were observed (1.7 percent). Conclusions Endoscopic argon plasma ablation therapy is useful in the management of bleeding from colonic angiodysplasia. Presented at Digestive Digest Week, New Orleans, Louisiana, May 15 to 20, 2004.