内镜下大肠息肉切除术个体化治疗方案的选择

目的探讨内镜下大肠息肉切除术的个体化治疗方案的选择。方法对2009年3月至2013年10月昆明市第一人民医院内镜检查发现的315例患者,共行411次大肠息肉切除及镜下治疗方案进行分析,(对于山田分型Ⅰ型^Ⅲ型,<0.5 cm的143枚行氩气刀或热活检钳治疗;山田分型Ⅰ型Ⅲ型,<0.5 cm的143枚行氩气刀或热活检钳治疗;山田分型Ⅰ型^Ⅲ型,大小0.5Ⅲ型,大小0.5².0 cm的36枚,行黏膜下注射后高频电切除术;山田分型Ⅱ型2.0 cm的36枚,行黏膜下注射后高频电切除术;山田分型Ⅱ型^Ⅳ型232枚,可直接高频电切或先以尼龙绳圈套处理粗大的蒂部后再行高频电切除术。结果 411次切除病例中,手术出血16例,穿孔0例,感染0例,死亡0例。结论大肠息肉的内镜下治疗,根据息肉分型、大小、基底宽度采用不同的方法进行切除,使得镜下治疗安全有效,病灶切除完整,避免不必要的开腹手术,是一种行之有效的个体化治疗方案。

Individualized Endoscopic Resection of Colorectal Polyps Programs

Objective To discuss how to choose the individualized endoscopic resection of colorectal polyps program. Methods To analyze 315 patients’ colorectal polyps found by endoscopic examination in the First People’s Hospital of Kunming from March,2009 to October, 2013, who were given altoghter 411 polypectomies, together with their endoscopic treatment results. The 143 cases of polyp lesions which belong to Yamada typeⅠ-Ⅲand smaller than 0.5cm were given endoscopic Argon Plasma Coagulation（APC）or hot biopsy forceps treatment;the 36 cases of polyp lesions which belong to Yamada typeⅠ-Ⅲand whose size is between 0.5cm and 2.0cm were given submucosal injection and then high frequency electric resection;the 232 cases of polyp lesions which belong to Yamada typeⅡ-Ⅳwere directly given high frequency electric resection or their thick pedicles were first processed by nylon rope snare and then given high frequency electric resection. Results Among all the 411 cases of excision,there were 16 cases of intraoperative blood loss,no perforation, no infection and no death. Conclusion Endoscopic treatment of colorectal polyp, which may be a successful individualized treatment plans ,should adopt different ways to excise according to the type,size,base width of the polyps so that the endoscopic treatment may be safe and effective to excise the focus of infection completely and avoid unnecessary laparotomy.