483例内镜下治疗上消化道息肉临床分析.docVIP

483例内镜下治疗上消化道息肉临床分析 　　作者：欧阳玉洁,龙泽民　　作者单位：深圳市南山区蛇口人民医院消化科，广东 深圳 　　【摘要】目的：探讨上消化道息肉内镜下治疗的方法。方法：对我院2006年4月～2011年3月经内镜下治疗的483例上消化道息肉患者临床资料进行回顾性分析。结果：483例上消化道息肉患者，共摘除1 077枚息肉，用EMR切除4枚，直接用圈套器电凝电切44枚，氩气APC治疗143枚，微波切除412枚，热活检钳切除21枚，直接钳除453枚，其中有8例患者因息肉过大或息肉过多，分2次摘除，摘除成功率100%。12枚息肉切除后即刻有创面渗血，其中电凝电切组出血6例(13.64%)，微波治疗组出血1例(0.24%)，热活检治疗组出血2例(9.52%)，直接钳除组出血3例(0.66%)，EMR及APC组无并发出血，10例给予1∶10 000去甲肾上腺素盐水喷洒或微波凝固或钛夹止血或尼龙绳套扎止血治疗，止血成功，2例自行凝血。110例患者复查胃镜，其中98例(89.1%)无息肉复发，12例(10.9%)复发。其中9例再次以活检钳直接钳除，3例行微波治疗。结论：上消化道息肉是临床较常见病，需积极治疗。内镜下治疗操作简便，有效、安全，首选APC及EMR治疗。治疗后注意息肉回收、病理检查及内镜复查。 　　【关键词】 上消化道息肉,内镜治疗,氩离子凝固术;注射后切除 　　[ABSTRACT] Objective： To discuss the endoscopic treatment for upper gastrointestinal polyp. Methods： Clinical data of 483 cases with upper gastrointestinal tract polyps admitted from April 2006 to March 2011 in our hospital were retrospectively analyzed. Results： In 483 patients with upper gastrointestinal tract polyps， 1 077 lesions of upper gastrointestinal tract polyps totally were removed，including 4 by EMR， 44 by electrocoagulation and electrosection， 143 by Argon plasma coagulation， 412 by microwave excision， 21 by hot biopsy， 453 by direct clamp resection. Eight cases were treated twice because of too many polyps or too large size， and were treated successfully. Blood oozed from the wound surface in 12 cases (1.08%) after excision， including 6(13.64%) with electrocoagulation and electrosection， 1(0.24%)with microwave excision， 2(9.52%) with hot biopsy， 3(0.66%)with direct clamp resection. 10 cases had hemostatic treatment by norepinephrine saline spray or microwave coagulation or titanium clamp or nylon loop ligature. 2 cases had self-coagulation. A total of 110 patients had recheck by gastroscope， in which 98 cases(89.1%) had no recurrence; 12 cases(10.9%) had relapse， 9 cases (8.2%)were treated by direct clamp resection and 3(2.7%) received routine microwave treatment. Conclusions： Endoscopic treatment is of simple operation， effective and safe. APC and EMR trea