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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (02) : 73 -82. doi: 10.3877/cma.j.issn.2095-7157.2023.02.001

共识与指南

中国结直肠息肉冷切专家共识(2023年,杭州)
中华医学会消化内镜学分会   
  1. 100710 北京,中华医学会消化内镜学分会
  • 收稿日期:2023-04-25 出版日期:2023-05-15

Chinese expert consensus on cold snare polypectomy for colorectal polyps (2023, Hangzhou)

Chinese Society of Digestive Endoscopology, Beijing 100710, China   

  • Received:2023-04-25 Published:2023-05-15
引用本文:

中华医学会消化内镜学分会. 中国结直肠息肉冷切专家共识(2023年,杭州)[J]. 中华胃肠内镜电子杂志, 2023, 10(02): 73-82.

Chinese Society of Digestive Endoscopology, Beijing 100710, China. Chinese expert consensus on cold snare polypectomy for colorectal polyps (2023, Hangzhou)[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(02): 73-82.

结直肠息肉的早期发现和及时治疗是降低结直肠癌发病率和死亡率的有效手段。内镜下圈套器冷切除术(CSP)在结直肠息肉治疗中发挥着重要作用,但是目前国内尚无规范化治疗的相关共识。2023年,中华医学会消化内镜学分会组织全国领域内权威专家讨论,结合国内外最新循证医学证据,形成了中国结直肠息肉冷切专家共识,以期规范该技术在结直肠息肉中的应用。本共识意见包括:适应证选择、操作步骤规范化、安全性评价、标本处理及术后管理等5个部分,共18条陈述。

Early detection and prompt treatment of colorectal polyps are effective for reducing the incidence and mortality of colorectal cancers.Endoscopic cold snare polypectomy (CSP) plays an important role in the treatment of colorectal polyps.However, no specific consensus on CSP procedure has been published in China. In 2023, Based on the latest domestic and foreign evidence-based evidence, authoritative experts in the field all over the country under the leadership of Chinese Society of Digestive Endoscopology conducted a comprehensive discussion and proposed the consensus, to serve as a tool for Chinese endoscopists to standardize CSP procedure for colorectal polyps.There are five parts in the consensus, with 18 recommendations, including selection of indications, standardization of CSP procedure, evaluation of safety, processing of specimen, and post-procedural management.

表1 证据质量的推荐分级评估、制定和评价
表2 推荐强度分级
表3 改良Delphi方法的共识投票意见选项
表4 达成共识的陈述条款
推荐意见 证据质量 推荐强度 共识水平(%)
一、CSP适应证      
陈述1:推荐CSP用于直径<10 mm的非癌性非带蒂结直肠息肉。 A 1 100
陈述2:目前无充分证据支持CSP用于直径为10~19 mm的非带蒂结直肠息肉。 B 1 96.43
陈述3:不推荐CSP用于直径≥20 mm的非带蒂结直肠息肉。 B 1 100
陈述4:目前无充分证据支持CSP用于头端直径<10 mm的带蒂结直肠息肉,不推荐CSP用于头端直径≥10 mm的带蒂结直肠息肉。 C 1 92.31
二、CSP操作规范      
陈述5:推荐CSP术前常规使用白光内镜、NBI等电子染色内镜、色素内镜或放大内镜详细评估结直肠息肉大小、形态、边界及性质。 C 1 100
陈述6:推荐使用标准步骤实施CSP手术。 C 2 95.83
陈述7:CSP术前不需要常规进行黏膜下注射。 B 1 100
陈述8:建议选用专用冷圈套器实施CSP操作。 A 1 82.14
陈述9:CSP无法顺利完成息肉切除时可采用"三步法"解决。 D 2 82.14
陈述10:CSP术后创面出现的白色突起物不需要特殊处理。 B 1 100
三、CSP安全性      
陈述11:CSP术中出血大部分能够自行停止,无需常规进行高频电凝止血或金属夹止血。 A 1 96.43
陈述12:CSP术后迟发性出血的发生率较低,可根据情况选择保守治疗、内镜治疗等。 A 1 100
陈述13:使用抗栓药物患者CSP术后迟发性出血低于HSP。 A 1 82.14
陈述14:CSP穿孔发生率很低,不推荐CSP术中常规闭合创面。 A 1 92.86
四、CSP标本处理      
陈述15:建议将收集到的CSP标本分别装入标本瓶,进行病理学评估。 C 2 82.14
陈述16:不推荐常规使用大头针固定CSP标本,但可考虑将标本平铺在滤纸上以辅助判断完整切除情况。 C 2 86.21
五、CSP术后管理      
陈述17:CSP术后建议采取风险分层,低危腺瘤患者应在3年内复查结肠镜,高危腺瘤患者结肠镜复查时间应缩短至1~2年。 B 1 85.71
陈述18:CSP术后病理证实存在癌变且病理无法准确评估切缘及黏膜下浸润深度时,应及时进行全面评估,必要时追加内镜治疗或外科手术。 C 1 80.77
图1 内镜下圈套器冷切除术的操作步骤注:A:白光观察息肉;B:NBI观察息肉,NICE分型为2型;C:将息肉调整至内镜视野5~6点钟方向,圈套器外鞘管靠近息肉评估息肉大小;D:打开圈套器,圈套器尖端紧贴息肉口侧正常黏膜,并稍下压,套入息肉周围正常组织1~2 mm;E:逐步收紧圈套器直至息肉切除;F:息肉顺利切除;G:通过吸引通道回收标本并冲洗创面后观察创面边缘是否存在息肉残留;H:结合NBI观察创面边缘是否存在息肉残留
图2 CSP术后创面白色突起物注:A:白光观察息肉;B:圈套器冷切除息肉;C:术后创面见白色突起物;D:冲水后白色突起物消失
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