«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年02期

页码:

170-173

栏目:

临床医学

出版日期:

2023-03-20

文章信息/Info

Title:

Application of endoscopic mucosal resection in the treatment of large colonic polyps in children

文章编号:

1006-8147（2023）02-0170-04

作者:

田琪; 董亮; 李金鑫; 李苗苗; 崔华雷

天津市儿童医院微创外科，天津300074

Author(s):

TIAN Qi; DONG Liang; LI Jin-xin; LI Miao-miao; CUI Hua-lei

Department of Minimally Envasive Surgery，Tianjin Children′s Hospital，Tianjin 300074，China

关键词:

结肠大息肉; 儿童; 手术方式

Keywords:

children; large polyps; surgical methods

分类号:

R726.5

DOI:

-

文献标志码:

A

摘要:

目的：探讨内镜下黏膜切除术（EMR）治疗儿童结肠大息肉的临床应用价值。方法：回顾性分析天津市儿童医院行结肠镜下息肉切除术的结肠大息肉（息肉直径≥10mm）病例141例，其中行EMR的病例69例为观察组。行结肠镜下高频电凝电切除术的病例72例，设定为对照组，对比两组手术时间、并发症发生率及术后恢复时间及术后住院时间等，探讨不同手术方式治疗儿童结肠大息肉的手术效果和安全性。结果：两组患者年龄结构、性别组成及术前临床表现等多方面差异无明显统计学意义（均P>0.05）。与对照组相比，观察组手术时间长[（27.44±2.61）minvs.（31.72±3.92）min]，两组间差异具有统计学意义（t=7.661，P＜0.05）。与对照组相比，观察组术后便潜血转阴时间[（2.46±0.52）dvs.（1.72±0.41）d]、肠道恢复时间[（2.47±0.35）dvs.（1.86±0.44）d]、术后住院时间[（6.41±0.95）dvs.（5.21±0.86）d]更短，差异均具有统计学意义（均P＜0.05）。术后并发症情况比较，观察组出血5例（7.3%）、穿孔0例、息肉切除术后电凝综合征1例（1.5%），并发症总数6例（8.7%）；对照组出血12例（16.7%）、穿孔1例（1.4%）、息肉切除术后电凝综合征2例（2.8%），并发症总数15例（20.8%）。并发症总体发病率差异具有统计学意义（χ2=4.095，P＜0.05）。结论：与内镜下高频电凝电切除术相比，EMR在治疗儿童结肠大息肉的临床疗效及安全性方面具有明显的优势。

Abstract:

Objective：To explore the clinical value of endoscopic mucosal resection（EMR）in the treatment of large colonic polyps in children. Methods：Retrospective analysis was made on 141 cases of large colon polyps（polyp diameter greater than or equal to 10 mm） who underwent colonoscopic polypectomy in Tianjin Children′s Hospital. Among them，69 cases underwent EMR as observation group， 72 cases of high frequency electrocoagulation resection under colonoscopy were set as reference group. The operation time，complication rate，postoperative recovery time and postoperative hospital stay of the two groups were compared to explore the effect and safety of different surgical methods in the treatment of large colonic polyps in children. Results：There was no significant difference in age structure，sex composition and preoperative clinical manifestations between the two groups（all P>0.05）. The operation time（min）was（31.72±3.92） in the observation group and（27.44±2.61）in the reference group. The difference between the two groups was statistically significant （t=7.661，P<0.05）. The time of stool occult blood turning negative after operation（days）was（1.72±0.41）in the observation group and （2.46 ± 0.52）in the reference group. Intestinal recovery time（days）was（1.86 ± 0.44）in the observation group and（2.47±0.35）in the reference group. Postoperative hospital stay（days）was（5.21±0.86）in the observation group and（6.41±0.95）in the reference group. The difference between the two groups was statistically significant（all P<0.05）. The postoperative complications of the two groups were compared. In the observation group，there were 5 cases of bleeding（7.3%），0 cases of perforation，1 case of electrocoagulation syndrome after polypectomy（1.5%），and the total number of complications was 6 cases（8.7%）. In the reference group，bleeding occurred in 12 cases（16.7%），perforation in 1 case（1.4%），and electrocoagulation syndrome after polypectomy in 2 cases（2.8%）. The total number of complications was 15 cases（20.8%）. The overall incidence rate of complications between the two groups was statistically significant（χ2=4.095，P＜0.05）.Conclusion：Compared with endoscopic high-frequency electrocoagulation，EMR has obvious advantages in clinical efficacy and safety in the treatment of large colonic polyps in children.

参考文献/References:

[1] 桑建忠，张红，周建波，等．结肠息肉内镜下切除术 后迟发性出血的危险因素[J]．中华消化杂志，2017，37（12）：835-838．
[2] 王淑君，周平红，王益平，等.内镜黏膜下剥离术 治疗结直肠粗短蒂息肉的疗效评价[J].中华消化内镜杂志，2019（5）：358-360.
[3] 汪洋，叶琦刚，盛显仓，等. 3种不同内镜方 法治疗结肠粗蒂大息肉的对 比研究[J].浙江医学，2020，42（1）：44-47.
[4] GUPTA S K，FITZGERALD J F，CROFFIE J M，et al. Experience with juvenile polyps in North American children：the need for pan colonoscopy[J]. Am J Gastroenterol，2001，96（6）：1695-1697.
[5] CORREDOR J，WAMBACH J，BARNARD J. Gastrointestinal polyps in children：advances in molecular genetics，diagnosis，and manage－ment[J]. J Pediatr，2001，138（5）：621-628.
[6] RAHMATALLAH Y，KHAIDAKOV M，LAI K K，et al. Platform-independent gene expression signature differentiates sessile serrat－ed adenomas/polyps and hyperplasic polyps of the colon[J]. BMC Med Genomics，2017，10（1）：81.
[7] SUNG JJY，LAU JYW，YOUNG G P，et al. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening[J]. Gut， 2015，64（1）：121.
[8] MEESTER R G，DOUBENI C A，LANSDORPVOGELAAR I，et al. Variation in adenoma detection rate and the lifetime benefits and cost of colorectal cancer screening：amicro simulation model[J]. JA－MA，2015，313（23）：2349-2358.
[9] 包晓敏.炎症性肠病应用 消化内镜与多层螺旋C小肠造影诊断的应用 观察[J].影像研究与医学应用，2021，5（19）：108-109.
[10] GAGLIA A，SARKAR S. Evaluation and long-term outcomes ofthe different modalities used in colonic endoscopic mucosal resection [J]. Ann Gastroenterol，2017，30（2）：145-151.
[11] FERLITSCH M，MOSS A，HASSAN C，et al. Colorectal polypectomy and endoscopic mucosal resection（EMR）：european society of gas－trointestinal endoscopy（ESGE）clinical guideline [J].Endoscopy， 2017，49（3）：270-297.
[12] DUMOULIN F L，HILDENBRAND R. Endoscopic resection tech－niques for colorectal neoplasia：current developments [J]. World J Gastroenterol，2019，25（3）：300-307.
[13] NOMURA S，SHIMURA T，KATANO T，et al. A multicenter，single-blind randomized controlled trial of endoscopic clipping closure for preventing coagulation syndrome after colorectal endoscopic sub mucosal dissection[J]. Gastrointest Endosc，2020，91（4）：859-867.
[14] LONG CROFT WHEATON G，BHANDARI M，ALKANDARI A，et al. Recent advances in the management of large and complex colonic polyps[J]. F1000 Res，2018，7：304.
[15] YAMASAKI Y，TAKEUCHI Y，IWATSUBO T，et al. Line-assisted complete closure for a large mucosal defect after colorectal endo－scopic sub mucosal dissection decreased post-electro coagulation syndrome [J]. Dig Endosc，2018，30（5）：633-641.

相似文献/References:

[1]刘 艳,张碧丽,王文红,等.儿童肾病综合征合并真菌感染临床分析[J].天津医科大学学报,2013,19(06):496.
[2]宋国超,王雪艳,王 峥,等.天津地区儿童血清特异性IgE过敏原临床分析[J].天津医科大学学报,2014,20(06):477.
[3]卢 洁,薛海玲. 天津市区儿童肺炎支原体肺炎发病情况调查分析[J].天津医科大学学报,2015,21(02):174.
[4]刘 静,孟昭学.北京市通州区3～6岁儿童气质类型分布及气质维度特点分析[J].天津医科大学学报,2015,21(03):261.
[5]耳文元. 幼儿46，X，I（Xq）型Turner 综合征1例报道[J].天津医科大学学报,2015,21(01):58.
[6]王 瑜,郑荣秀.儿童嗜酸性胃肠炎伴血性腹水1例报道[J].天津医科大学学报,2016,22(06):491.
[7]王晓晓,周宇辉,王 倩,等.氨基末端脑钠肽前体水平对丙种球蛋白无反应性川崎病的预测价值[J].天津医科大学学报,2016,22(06):502.
　WANG Xiao-xiao,ZHOU Yu-hui,WANG Qian,et al.Predictive value of plasma brain natriuretic peptide in IVIG-resistant Kawasaki disease[J].Journal of Tianjin Medical University,2016,22(02):502.
[8]郭永盛,邹映雪,翟 嘉,等.73例儿童型塑型性支气管炎临床特征分析[J].天津医科大学学报,2017,23(05):422.
　?[J].Journal of Tianjin Medical University,2017,23(02):422.
[9]吴 文,崔华雷,王晓晔,等.腹腔镜治疗小儿鞘膜积液疗效观察[J].天津医科大学学报,2017,23(05):462.
[10]李静,刘长山,王雪艳,等.儿童肺炎支原体肺炎肺功能改变及临床意义的探讨[J].天津医科大学学报,2018,24(03):229.

备注/Memo

备注/Memo:

基金项目： 天津市科技计划项目（14RCGFSY00150）
作者简介： 田琪（1975-），男，副主任医师，硕士，研究方向：小儿外科；
通信作者：崔华雷，E-mail：chlfjp@sina.com。

常用功能

更新日期/Last Update: 2023-04-30