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目的旨在对不同形态、大小的消化道息肉,在消化内镜下分别采用不同摘除法的疗效、安全性及相应推广价值进行探讨。方法治疗方案:①对小于0.5 cm的息肉,多采用热活检夹除或氩气灼除法。②对大于0.5 cm有蒂或亚蒂息肉,采用直接圈套切除。③对广基息肉,先在息肉周边进行黏膜下多点注射,使息肉隆起后,再采用电切的方法进行治疗。④通电前一定要提起息肉,避免高频电流造成肠壁深层的灼伤;使用高频电刀时一般采用先电凝,再电切,反复间断多次通电。结果所有病例均治疗成功。其中3例治疗后发生大出血,急查内镜、并行内镜下补救治疗(钛夹和黏膜下注射);1例疑似穿孔拍片,膈下未发现游离气体,嘱患者卧床休息并给予抗炎治疗后症状消失;9例较大息肉圈套切除时因圈套过快,导致息肉残端出血,当即以氩气/热活检钳和黏膜下注射压迫止血。其他病例均未作特殊处理。所有病例术后15～30d复查内镜,创面均完全愈合,均无息肉的残留或复发,目前尚对患者长期的随访中。结论内镜下治疗消化道息肉因其创伤小、愈合快、安全可靠、疗效显著应为首选。有利于广大基层医疗机构推广,具有较为广阔的发展前景。
The purpose of this study was to explore the efficacy, safety and corresponding promotion value of different ablation methods under different conditions of digestive endoscopy in different forms and sizes of gastrointestinal polyp. Methods of treatment: ① less than 0.5 cm of polyps, the more hot biopsy clip or argon burning method. ② more than 0.5 cm pedicle or pedicle polyps, the use of direct snare excision. ③ on the wide-based polyps, polyp first in the polyps around the multi-point injection, the polyps uplift, and then use the method of electrical cutting for treatment. ④ must be brought before the power polyp, to avoid high-frequency current caused by deep intestinal wall burns; the use of high-frequency electric knife when the general use of the first coagulation, and then cut, repeated intermittent power. Results All cases were successfully treated. Among them, 3 cases had massive hemorrhage after treatment, emergency endoscopy and endoscopic remediation (titanium clip and submucosal injection); 1 suspected perforation film, no free gas under the diaphragm, and told the patient to rest in bed and give anti-inflammatory treatment After the symptoms disappeared; 9 cases of larger polyps trap resection due to snare too fast, resulting in polyp stump bleeding, immediately to the argon / hot biopsy forceps and submucosal injection oppression to stop bleeding. No other cases were specially treated. In all cases, endoscopy was performed 15 to 30 days after operation, and the wounds were completely healed. No residual or recurrence of polyps was found, and the patients were still followed up for a long time. Conclusion Endoscopic treatment of gastrointestinal polyps due to its small trauma, rapid healing, safety and reliability, efficacy should be the first choice. Is conducive to the promotion of the broad grass-roots medical institutions, with a broader development prospects.