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目的探讨靛胭脂肾上腺素混合溶液在大肠巨大息肉(直径≥2cm)内镜下切除术中的作用。方法 33例患者(46枚大肠巨大息肉)术前1d常规服用25%硫酸镁溶液清洁肠道,术中先用内镜注射针在息肉(不论有蒂、亚蒂、无蒂息肉)基底部黏膜下注射靛胭脂+肾上腺素+生理盐水混合溶液(靛胭脂:肾上腺素:生理盐水=3-5ml∶1ml∶100ml),使局部黏膜肿胀、隆起后,再将息肉圈套切除。结果 15枚有蒂息肉、20枚亚蒂息肉及11枚无蒂息肉中,除1例无蒂息肉行分片切除外,其余息肉均一次性圈套切除。除1例术中出现少量出血外,其余患者均未出现术中出血、穿孔及术后迟发性出血、穿孔等并发症发生。术后病理活检发现1枚管状绒毛状腺瘤合并癌,该患者转外科手术治疗,其余息肉病理活检为管状腺瘤22枚,绒毛状腺瘤17枚,管状绒毛状腺瘤6枚。结论预注射靛胭脂肾上腺素混合溶液不但有助于术者判断息肉切除范围及深度,避免穿孔并发症的发生,还可以减少大肠巨大息肉内镜下切除术后出血风险,且有利于术后创面处理。
Objective To investigate the role of indigoine epinephrine mixed solution in endoscopic polypectomy of colorectal polyps (diameter ≥2cm). Methods Thirty-three patients (46 large intestine giant polyps) were routinely given 25% magnesium sulfate solution to clean the intestine one day prior to surgery. The endoscopic injection needle was used to treat the basal mucosa of polyps (pedicled, pedunculated, pedunculated polyps) Injecting indigo + epinephrine + saline mixed solution (indigo rouge: epinephrine: saline = 3-5ml: ml: 100ml), so that the local mucosal swelling, uplift, and then remove the polyp trap. Results Fifteen pedunculated polyps, 20 pedicle polyps and 11 pedicle polyps were excised in one polyp. In addition to a small amount of intraoperative bleeding occurred, the remaining patients did not appear intraoperative bleeding, perforation and postoperative delayed bleeding, perforation and other complications. Postoperative pathological biopsy revealed a tubular villous adenoma with cancer. The patient underwent surgical treatment. The remaining polyp biopsies were 22 tubular adenomas, 17 villous adenomas and 6 tubular villous adenomas. Conclusion Preinjection of indigoine epinephrine mixed solution will not only help the surgeon to determine the scope and depth of polyp resection and avoid the occurrence of perforation complications, but also reduce the risk of hemorrhage after endoscopic polypectomy of giant polyps. It is also beneficial to the postoperative wound healing deal with.