冷圈套联合黏膜下注射对结直肠(微)小息肉的完整切除率的研究

doi:10.3877/cma.j.issn.2095-7157.2019.01.001

中华胃肠内镜电子杂志 ›› 2019, Vol. 06 ›› Issue (01) : 1 -6. doi: 10.3877/cma.j.issn.2095-7157.2019.01.001

所属专题：文献；

论著

冷圈套联合黏膜下注射对结直肠(微)小息肉的完整切除率的研究

谢娇¹, 王雯²^,^†(

), 李达周², 叶舟², 许斌斌², 徐桂林², 洪东贵², 曾茹娇²

^1. 350025　福州，厦门大学附属东方医院；350025　福州，解放军联勤保障部队第九〇〇医院消化内科
^2. 350025　福州，解放军联勤保障部队第九〇〇医院消化内科

收稿日期:2018-12-31 出版日期:2019-02-15
通信作者: 王雯
基金资助:
国家科技支撑计划(2105BA13B08); 福建医科大学起航(2017XQ1197)

Complete resection rate of cold snare polypectomy with injection(CSPI) for diminutive and small colorectal polyps

Jiao Xie¹, Wen Wang²^,^†(), Dazhou Li², Zhou Ye², Binbin Xu², Guilin Xu², Donggui Hong², Rujiao Zeng²

^1. Department of Gastroenterology.Dongfang Hospital Affiliated to Xiamen University；900 Hospital of the Joint Logistics Team, Fuzhou 350025, China
^2. 900 Hospital of the Joint Logistics Team, Fuzhou 350025, China

Received:2018-12-31 Published:2019-02-15
Corresponding author: Wen Wang
About author:
Corresponding author: Wang Wen, Email: wangwenfj@163.com

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引用本文：

谢娇, 王雯, 李达周, 叶舟, 许斌斌, 徐桂林, 洪东贵, 曾茹娇. 冷圈套联合黏膜下注射对结直肠(微)小息肉的完整切除率的研究[J/OL]. 中华胃肠内镜电子杂志, 2019, 06(01): 1-6.

Jiao Xie, Wen Wang, Dazhou Li, Zhou Ye, Binbin Xu, Guilin Xu, Donggui Hong, Rujiao Zeng. Complete resection rate of cold snare polypectomy with injection(CSPI) for diminutive and small colorectal polyps[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2019, 06(01): 1-6.

目的

肠镜下切除的结直肠息肉绝大多数为微小息肉(≤5 mm)或小息肉(6～10 mm)，对于此类息肉的最佳切除方法目前缺乏统一指南。本研究旨在探究冷圈套息肉切除术联合黏膜下注射治疗结直肠息肉(直径≤10 mm)的可行性和有效性。

方法

本研究前瞻性随机选取2018年1月至2018年12月经解放军联勤保障部队第九〇〇医院消化内科行结肠镜检查发现结直肠息肉(直径≤10 mm)的300例患者进行对照研究，按1∶1随机分配接受冷圈套息肉切除术联合黏膜下注射(CSPI)或冷圈套息肉切除术(CSP)治疗。其中CSPI组在切除息肉之前先进行黏膜下注射，再行息肉切除，而CSP组则套取息肉后直接切除，然后在内镜窄带成像技术(NBI)引导下对息肉切除部位底部及侧切缘活检2～3块，用于病理组织学评估切除完整率。术中记录息肉切除时间、息肉回收情况和并发症。

结果

纳入研究的300例患者，CSPI组(n ＝150)和CSP组(n＝150)病灶平均大小分别为7.7 mm和6.7 mm。患者的性别、年龄等及息肉部位、大小、形态、分型在组间均衡。CSPI与CSP相比完全切除率为96.7% vs 76.6%，差异具有统计学意义(P<0.001)。所有息肉均回收，其中9例CSP患者出现术中出血，CSPI组无术中出血，差异具有统计学意义(P<0.05)；所有患者均无迟发性出血、穿孔等并发症。

结论

尽管CSPI较单纯采用冷圈套的治疗时间长，但却是一种安全、有效的息肉切除术，尤其对于6～10 mm息肉其全切除率高达98.9%，并且手术相关并发症发生率较低。

关键词: 结直肠息肉, 冷圈套息肉切除术, 黏膜下注射, 全切除率, 并发症

Objective

The majority of polyps removed at colonoscopy are diminutive (≤ 5 mm) to small(6-10 mm) and there are few guidelines for the best way for these polyps to be removed. We aimed to assess the feasibility and effectiveness of cold snare polypectomy with injection(CSPI) for polyps ≤10 mm.

Methods

This study prospectively and randomly selected 300 patients with colorectal polyps (diameter ≤ 10 mm) found by colonoscopy in the gastroenterology department of 900 Hospital of the Joint Logistics Team from January 2018 to December 2018 for a control study, candidates were randomized (1∶1)to be treated with either cold snare polypectomy with injection(CSPI) or cold snare polypectomy(CSP). A small submucosal injection was administered prior to removal of the polyp using cold snare in the CSPI, whlie not in CSP.After polypectomy, an additional 2-3 forceps biopsies under narrow-band imaging (NBI) were performed at the base and margins of polypectomy sites to assess completeness of resection. Polypectomy timing, retrieval and complications were recorded at the time of the procedure.

Results

Three hundred patients were recruited with mean lesion size of polyps 7.7 mm in CSPI group(n=150) and 6.7 mm in CSP group(n=150). The patients′ baseline characteristics and the location, size and shape of polyps removed were similar between the 2 groups.The complete resection rate (CRR) was respectively with CSPI and CSP 96.7% vs.76.6%, (P<0.001), there was significant difference between the two groups.Retrieval was completed for all polyps.Immediate bleeding during the procedure was more common in CSP has 9 cases , but no occurred in CSPI group (P<0.05), the difference was statistically significant, and there were no delayed bleeding or delayed perforation after polypectomy.

Conclusions

Cold snare polypectomy with injection is a safe and effective technique for polyps, with a high complete resection especially for 6-10 mm polyps reach to 98.9%, and low procedure-related adverse events, but the time taken for the procedure is greater than cold snare.

Key words: Colorectal Polyps, Cold snare polypectomy, Submucosal injection, Complete resection rates, Procedure-related adverse events

图2 (A-E)CSP

图1 (A-E)CSP联合黏膜下注射

表1 CSP和CSPI组患者及息肉切除一般情况

组别	性别		年龄(岁)	肠道准备评分(分)(BBPS评分)	息肉切除时间(min)	息肉回收率(%)	回盲部插管率(%)
组别	男	女	年龄(岁)	肠道准备评分(分)(BBPS评分)	息肉切除时间(min)	息肉回收率(%)	回盲部插管率(%)
CSP(n＝150)	78	72	60.72±7.3	7.7±2.11	3.24±1.05	100	97.14
CSPI(n＝150)	81	69	62.13±6.8	7.5±2.28	3.45±1.12	100	94.29
P值	0.919		0.084	0.431	0.095	－	0.748

表1 CSP和CSPI组患者及息肉切除一般情况

组别	性别		年龄(岁)	肠道准备评分(分)(BBPS评分)	息肉切除时间(min)	息肉回收率(%)	回盲部插管率(%)
组别	男	女	年龄(岁)	肠道准备评分(分)(BBPS评分)	息肉切除时间(min)	息肉回收率(%)	回盲部插管率(%)
CSP(n＝150)	78	72	60.72±7.3	7.7±2.11	3.24±1.05	100	97.14
CSPI(n＝150)	81	69	62.13±6.8	7.5±2.28	3.45±1.12	100	94.29
P值	0.919		0.084	0.431	0.095	－	0.748

表2 切除息肉一般情况

组别	大小(mm)	部位			形态(巴黎分型)			NICE分型
组别	大小(mm)	左半结肠	横结肠	右半结肠	Ip	Is	Isp	增生性息肉	腺瘤	腺癌
CSP(n＝150)	6.78±2.23	42	75	33	32	55	63	71	78	1
CSPI(n＝150)	7.72±1.87	39	66	45	41	57	52	59	85	2
P值	0.071	0.282			0.333			0.574

表2 切除息肉一般情况

组别	大小(mm)	部位			形态(巴黎分型)			NICE分型
组别	大小(mm)	左半结肠	横结肠	右半结肠	Ip	Is	Isp	增生性息肉	腺瘤	腺癌
CSP(n＝150)	6.78±2.23	42	75	33	32	55	63	71	78	1
CSPI(n＝150)	7.72±1.87	39	66	45	41	57	52	59	85	2
P值	0.071	0.282			0.333			0.574

表3 CSP和CSPI组息肉切除治疗情况

组别	内镜下整块切除率(%)	组织学完全切除率(%)	不同大小息肉切除率		标本含黏膜下层率(%)	术中		术后2周(迟发性)
组别	内镜下整块切除率(%)	组织学完全切除率(%)	1～5 mm	6～10 mm	标本含黏膜下层率(%)	出血	穿孔	出血	穿孔
CSP(n＝150)	100	76.6(115/150)	72.1(44/61)	79.8(71/89)	59.3(89/150)	9	0	0	0
CSPI(n＝150)	100	96.7(145/150)	93.2(55/59)	98.9(90/91)	84.7(127/150)	0	0	0	0
P值	－	<0.001	0.005	<0.001	<0.001	0.003	－	－	－

表3 CSP和CSPI组息肉切除治疗情况

组别	内镜下整块切除率(%)	组织学完全切除率(%)	不同大小息肉切除率		标本含黏膜下层率(%)	术中		术后2周(迟发性)
组别	内镜下整块切除率(%)	组织学完全切除率(%)	1～5 mm	6～10 mm	标本含黏膜下层率(%)	出血	穿孔	出血	穿孔
CSP(n＝150)	100	76.6(115/150)	72.1(44/61)	79.8(71/89)	59.3(89/150)	9	0	0	0
CSPI(n＝150)	100	96.7(145/150)	93.2(55/59)	98.9(90/91)	84.7(127/150)	0	0	0	0
P值	－	<0.001	0.005	<0.001	<0.001	0.003	－	－	－

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