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目的探讨肠镜下结肠巨大息肉切除的临床可行性及操作要点。方法回顾性分析1999年5月至2006年5月在解放军第211医院消化科经电子肠镜检查发现直径>2cm结肠巨大息肉患者155例(171枚息肉)的临床资料。结果171枚息肉中经内镜黏膜切除(EMR)103枚(整块切除89枚,分2块切除14枚),均为1次肠镜完成。68枚带蒂息肉行高频电圈套切除17枚,采用银夹加高频电圈套切除33枚,行尼龙套扎加电凝电切18枚。并发症:即时出血量<20mL者5例;20~50mL者3例。1例创面距直肠7cm处息肉,切除24h后迟发出血300mL,经及时处理后止血。结论结肠巨大息肉可以经内镜切除,在超声微探头辅助下依息肉形态采用不同的切除方法。
Objective To investigate the clinical feasibility and operation points of large colon polypectomy under colonoscopy. Methods The clinical data of 155 patients (171 polyps) with a diameter greater than 2 cm in colon polyps from May 1999 to May 2006 in the Department of Gastroenterology of the No.211 Hospital of the People’s Liberation Army were retrospectively analyzed. Results Of the 171 polyps, 103 had endoscopic mucosal resection (EMR) (89 whole resections and 14 resections at 2 sites), which were all completed by 1 colonoscope. Twenty-eight pedo polyps were treated with high-frequency electric snares to remove 17 pieces, 33 pieces of silver clips and high-frequency electric snares were used for cutting, and 18 pieces of nylon ligatures and electric coagulation were cut. Complications: 5 cases of immediate blood loss <20mL; 3 cases of 20~50mL. One patient had a polyp at 7 cm from the rectum. He had a blood pressure of 300 mL after 24 hours of resection, and he stopped the bleeding after timely treatment. Conclusions Colonic giant polyps can be removed by endoscopy. Different polypectomy methods can be used depending on the polyp morphology with the aid of an ultrasound microprobe.