气囊辅助内镜对小肠息肉的治疗应用临床研究

发布时间：2018-01-25 15:05

本文关键词： 气囊辅助内镜小肠息肉镜下息肉切除回顾性分析　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：研究气囊辅助内镜(BAE)在小肠息肉治疗中的应用,探讨其作为小肠疾病治疗方法的可行性、安全性及临床价值。方法：回顾性总结中国人民解放军空军总医院消化内科白2006年8月至2014年7月临床收治的199例小肠息肉患者的临床资料,包括一般资料如年龄、性别、手术史、家族病史、首发症状等；199例患者进行气囊辅助内镜检查及内镜下息肉切除治疗情况：进镜途径、进镜深度、检查次数、镜下切除小肠息肉的数目、形态、大小及组织病理学结果等；术后并发症和对并发症的处理情况。对其中32例忠者,进行BAE治疗与于术治疗的住院费用、住院时间及术后胃肠动力恢复时间的比较。评价气囊辅助内镜作为小肠息肉治疗方式的可行性、安全性及临床应用价值。所有数据使用SPSS 19.0进行统计分析。结果：1.199例小肠息肉患者中男性110例,女性89例,包括Peutz-Jeghers综合征患者179例,家族性腺瘤性息肉病3例及其他空回肠息肉患者17例。2.199例患者共进行558例次气囊辅助内镜检查及治疗,内镜下治疗切除小肠息肉共3391枚,其中直径5-10mmm 801枚(23.62%),11-30mm 1887枚(55.65%),31-50mm 563枚(16.60%),大于50mmm 140枚(4.13%),最大者约为7cm*10cm。有蒂及亚蒂息肉2945枚(86.84%),无蒂及广基息肉446枚(13.16%)。199例患者中,有5例发生息肉癌变,其中2例有淋巴结转移,1例腹腔及肝脏转移。3.术后发生一过性的轻微腹痛、腹部不适、恶心、呕吐等不适症状者437例次,发生率为78.32%,21例次(3.76%)发生术后并发症,其中15例次术后息肉残根出血,12例经内科止血药物保守治疗后出血停止,2例再次进镜行内镜下止血治疗后出血停止,1例保守治疗无效转外科手术止血治疗。6例息肉镜下切除术后发生即时或延迟肠穿孔,经外科手术修补痊愈。无手术相关死亡病例发生。4.对32例患者进行外科手术治疗和BAE治疗的住院天数、住院费用及术后恢复时间进行配对样本t检验,P0.01,具有统计学意义,说明两种治疗方法存在差异。结论：BAE是一种行之有效的小肠息肉治疗方法,其突出的优点是可反复多次进行,尤其对多发息肉者可通过多次镜下治疗以将息肉全部切除,而且术后并发症少,较之外科手术具有创伤小,安全性较高,治疗成本较低的优势。对大多小肠息肉患者,可替代外科手术而作为首选治疗方法,具有较好的临床应用价值及发展前景。
[Abstract]:Objective: to study the application of balloon assisted endoscopy (BAE) in the treatment of intestinal polyps, and to explore the feasibility of using BAE as a treatment method for intestinal diseases. Safety and clinical value. Methods:. The clinical data of 199 cases of small intestinal polyps treated from August 2006 to July 2014 in the Department of Digestive Medicine, Air Force General Hospital of the Chinese people's Liberation Army (PLA) were retrospectively summarized. Including general data such as age, sex, surgical history, family history, initial symptoms and so on; 199 patients underwent balloon assisted endoscopy and endoscopic polyposectomy: approach, depth, times of examination, number and shape of small intestinal polyps resected under endoscope. Size and histopathological results; Postoperative complications and management of complications. 32 of them were treated with BAE and the cost of hospitalization. To evaluate the feasibility of balloon assisted endoscopy in the treatment of intestinal polyps. All the data were analyzed by SPSS 19.0. Results 110 cases were male and 89 cases were female in 1. 199 cases of small intestinal polyps. Including 179 patients with Peutz-Jeghers syndrome. 3 cases of familial adenomatous polyposis and 17 cases of other jejunal polyps were treated with balloon assisted endoscopy. A total of 3391 small intestinal polyps were treated by endoscopy, of which 801 of 5-10 mm in diameter were treated with 23.62% of them (11-30 mm, 1887 pieces, 55.65). 31-50 mm 563 pieces with 16.60 pieces, more than 50 mm and 140 pieces with 4.13). The largest was about 7 cm ~ (10) cm. There were 2945 pedicle and subpedicle polyps (86.84), 446 without pedicle and broad base polyps (13.16%) in 199 cases. There were 5 cases of polyp carcinogenesis, of which 2 cases had lymph node metastasis 1 case had abdominal and liver metastasis .3.After operation, 437 cases had temporary abdominal pain, abdominal discomfort, nausea, vomiting and other discomfort symptoms. The incidence of postoperative complications was 78.3232 and 21 cases (3.76). Among them, 15 cases had bleeding of residual root of polyps and 12 cases had stopped bleeding after conservative treatment with medical hemostatic drugs. 2 cases received endoscopic hemostasis after hemostasis and 1 case was retreated with conservative treatment and surgical hemostasis. 6 cases occurred immediate or delayed intestinal perforation after polyposcopy resection. No operation-related deaths occurred. 32 patients were treated with surgical treatment and BAE for days in hospital. The cost of hospitalization and postoperative recovery time were tested by paired t-test (P0.01), which was statistically significant. Conclusion the two methods are effective for the treatment of small intestinal polyps, the outstanding advantage of which is that they can be carried out over and over again. Especially for the patients with multiple polyps, the polyps can be completely resected through multiple endoscopy, and the complications are less, compared with surgery, the trauma is less and the safety is higher. For most of the patients with small intestinal polyps, it can be used as the first choice instead of surgery, which has good clinical application value and development prospect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.7

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