金属止血夹在儿童肠道粗蒂息肉内镜下切除术中的应用

目的　总结金属止血夹用于儿童粗蒂息肉切除的经验并对其应用技术、疗效及安全性进行探讨。方法　 2 0 0 1年 10月～ 2 0 0 2年 12月 ,利用富士 2 0 0型电子结肠镜、富士XQ2 0 0圈套器以及止血夹推送装置 (HX 5QR 1)和金属钛止血夹 (MD 85 0 ) ,对 5例直径 >1 0cm粗蒂息肉 ,采用止血夹钳夹结扎加电凝切除法 ,即利用止血夹钳夹息肉近基部蒂柄 ,完全阻断息肉血流 ,再行圈套电凝电切。本组 5例术前进行肠道准备 ,手术在静脉麻醉下进行 ,术后收集组织进行病理检查。结果　共切除息肉 6枚。其中横结肠息肉 2枚 ,降结肠息肉 4枚 ;幼年性息肉 3枚 ,腺瘤性息肉 3枚。所有息肉均完整切除 ,无出血及穿孔并发症 ;术后患儿症状消退。结论　金属止血夹能有效防止粗蒂息肉切除中的出血和穿孔并发症。内镜下金属止血夹加电凝切除术是一种安全、有效的治疗儿童胃肠粗蒂息肉方法

Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps

OBJECTIVE: With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety. METHODS: Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed. RESULTS: Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared. CONCLUSION: Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.