内镜下氩离子凝固术联合金属钛夹在大肠息肉电切术中的应用

发布时间：2018-08-17 18:42

【摘要】：目的:探讨氩离子凝固术联合金属钛夹在大肠息肉电切除术中的应用价值,并正确评价其治疗优势与效果。方法:选取我院2015年1月-2015年12月结肠息肉行内镜下治疗的患者415例,分成A、B、C三个治疗组,其中A组为应用高频电凝电切术后单纯氩离子凝固术处理创面治疗大肠息肉组147人,男性患者91例,女性患者56例,年龄31~80岁,其中60岁以下85人,60岁及以上62人;B组为应用高频电凝电切术后金属钛夹夹闭创面治疗大肠息肉组133人,男性患者79例,女性患者54例,年龄35~84岁,其中60岁以下76人,60岁及以上57人;C组为应用高频电凝电切术后氩离子凝固术联合金属钛夹夹闭创面治疗大肠息肉组135人,男性患者83例,女性患者52例,年龄33~79岁,其中60岁以下72人,60岁及以上63人。采用SPSSX~2检验方法对415例患者进行分析,分别计算上述三种方法治疗后出现的并发症,包括腹胀、腹痛、穿孔率和出血率,并对随访的三组患者观察治愈率及复发率,结合临床资料对氩离子凝固术联合金属钛夹在大肠息肉切除术中的作用与效果进行评估。结果:415例患者,三组所有病例术中术后穿孔率均为0,A组患者腹胀、腹痛发生率约21.8%;B组患者腹胀、腹痛发生率约15.8%;C组患者腹胀、腹痛发生率约12.6%。C组腹胀、腹痛发生率低于A组和B组,经过X~2检验统计学比较三组数值,X~2=4.388,p=0.111,p0.05,无差异,不具有统计学意义。A组患者出血发生率约8.16%,B组患者出血发生率约3.01%,C组患者出血发生率约2.22%,经过X~2检验统计学比较三组数值,X~2=6.791,p=0.034,p0.05,差异具有统计学意义。经过X~2检验统计学比较A组与C组出血并发症,X~2=4.932,p=0.026,差异有统计学意义(p0.05)。以上三组中出现出血的患者,使用急诊结肠镜下氩离子凝固术联合钛夹对出血创面再次处理后均未再出血。随访6个月后,三组患者中A组32例患者,复发4例,复发率为12.50%;B组26例患者,复发8例,复发率为30.77%;C组45例患者,复发4例,复发率为8.89%。通过X~2检验三组结果,X~2=6.338,p=0.042,差异有统计学意义(p0.05)。结论:氩离子凝固术联合钛夹电切治疗大肠息肉,术中及术后出现并发症可能性低,一次性切除率高,总治愈率高,复发率低。在大肠息肉治疗中氩离子凝固术联合钛夹可有效预防术中及术后并发症的发生,具有安全、有效及不易复发等临床特点。
[Abstract]:Objective: to evaluate the value of argon ion coagulation combined with titanium clip in electroresection of colorectal polyps. Methods: 415 patients with colonic polyps treated by endoscope from January 2015 to December 2015 in our hospital were divided into three groups: group A was treated with argon ion coagulation only after high frequency electrocoagulation. There were 91 male patients and 56 female patients aged 31 to 80 years. Among them, 85 patients under 60 years old and 62 patients over 60 years old were treated with metal titanium clip clamping wound after high frequency electrocoagulation for treatment of large intestinal polyp in 133 cases, male patients in 79 cases. 54 female patients, aged 35 to 84 years, including 76 patients under 60 years old and 57 patients over 60 years old, group C were treated with argon ion coagulation after high frequency electrocoagulation combined with metal titanium clip clamping wound in 135 patients with colorectal polyps, 83 male patients. There were 52 female patients aged 3379 years, including 72 patients under 60 years old and 63 patients over 60 years old. The complications, including abdominal distension, abdominal pain, perforation rate and bleeding rate, were calculated by SPSSX~2 test in 415 patients, and the cure rate and recurrence rate were observed. Combined with clinical data, the effect of argon ion coagulation combined with titanium clip in resection of colorectal polyp was evaluated. Results among 415 patients, the rate of perforation in all the three groups was abdominal distension in group A, the incidence of abdominal pain in group B was about 21.8B, the incidence of abdominal pain was about 15.8% in group C, and the incidence of abdominal pain in group C was about 12.6%. The incidence of abdominal pain in group A and group B was lower than that in group A and group B. there was no difference between the three groups by X2 test. The incidence of bleeding in group B was about 3.01%. The incidence of bleeding in group C was about 2.22%. After X2 test, the three groups were compared with each other by X2 test. The difference was statistically significant. The bleeding complications of group A and group C were compared statistically by X2 test. The difference was statistically significant (p0.05). The bleeding patients in the above three groups were treated with argon ion coagulation and titanium clip under emergency colonoscopy. After 6 months follow-up, there were 32 patients in group A, 4 patients in group A, 26 patients in group B with a recurrence rate of 12.50, 8 patients in group B, 45 patients in group C with a recurrence rate of 30.777am C, 4 patients in group A with a recurrence rate of 8.89. The results of the three groups were tested by X2, and the difference was statistically significant (p0.05). Conclusion: argon ion coagulation combined with titanium clip electrolysis for the treatment of colorectal polyps has a low possibility of complications during and after operation, a high rate of one-off resection, a high total cure rate and a low recurrence rate. Argon ion coagulation combined with titanium clip can effectively prevent intraoperative and postoperative complications in the treatment of colorectal polyps. It is safe, effective and difficult to recur.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656

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