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。

Study on Endoclip Combined with Endoloop Polypectomy in Large Pedunculated Colorectal Polyps

Background： Hemorrhage is the most common complication of polypectomy. Aims： To evaluate the efficacy and safety of combined endoclip and endoloop polypectomy in patients with large pedunculated colorectal polyps. Methods： Eighty-nine patients with large pedunculated polyps from June 2011 to August 2012 at Branch of Shanghai First People＇s Hospital were enrolled. Patients were treated with endoloop （ group A） and endoclip combined with endoloop （ group B ） polypectomy, respectively. Morphology, location, diameter of polyp and complication rate were retrospectively analyzed. Results： The most common morphology was Yamada type IV, and the most frequent polyp location was sigmoid colon in both group A and group B. No significant differenees in gender, age, mean sizes of head and pedicle of polyp were found between the two groups （ P 〉 0.05 ）. Incidences of bleeding during operation （ 12.8% vs. 10.0% ） and post-operation （ 10.3% vs. 4.0% ） were not significantly different between the two groups （P 〉0.05）, and all bleedings were stopped after proper treatment. Two patients in group A had polyp recurred 3 mouths after polypectomy, and the surgical wound of group B was healed with no residue polyp stump. Conclusions： Endoclip combined with endoloop is effective in preventing bleeding during or after polypectomy in large pedunculated colorectal polyps.