Uchiyama M, Iwafuchi M, Yagi M, Iinuma Y, Kanada S, Ohtaki M, Okamoto H, Hatakeyama K
Niigata University School of Medicine, Department of Pediatric Surgery, First Department of Surgery, Niigata, Japan.
Pediatr Int. 2001 Jun;43(3):259-62. doi: 10.1046/j.1442-200x.2001.01391.x.
Fiberoptic colonoscopy has been a routine therapeutic modality for colorectal polyps in pediatric patients. Methods of bowel preparation, anesthesia, area of investigation and treatment depending on histopathology are still controversial. In order to clarify the rationale of pediatric colonoscopy the present study was performed.
We analyzed the results of colonoscopic examination in 21 patients with colorectal polyps. Mean patient age was 3.7 years, with a range of 1--7 years. Rectal polyps were seen in 10 cases: seven had a solitary polyp (juvenile in six and adenoma in one) and three had multiple polyps (juvenile, lymphoid and Peutz--Jeghers coexisting with hyperplastic polyps). Sigmoid colon polyps were seen in 10 cases: all were solitary juvenile polyps, but one had adenomatous change. Another had multiple Peutz-- Jeghers polyps located in the entire colon. Flexible colonoscopic polypectomy was performed in 16 patients and transanal polypectomy was performed in four patients. Autoamputation was seen in two cases of juvenile polyp (resection was ultimately performed in a case having repeated autoamputation). After removing the polyps, all patients have had no recurrence for a period ranging from 6 months to 15 years, except for one case with Peutz--Jeghers syndrome.
Most polyps are located in the rectum or the sigmoid colon. Although the majority are solitary or juvenile polyps, because histopathologic variety is seen in pediatric colon polyps, histopathologic examination of each polyp is important to detect any dysplastic or adenomatous element with malignant potential and to make a suitable follow-up schedule. Symptomatic polyps should be removed by fiberoptic colonoscopy or transanal resection with total colon endoscopic examination under general anesthesia. Polypectomy using the electrocautery snare and clip is effective and safe and bowel preparation using polyethylene glycol electrolyte solution is sufficient for the procedure.
纤维结肠镜检查一直是儿科患者结直肠息肉的常规治疗方式。肠道准备方法、麻醉方式、检查及治疗范围（取决于组织病理学）仍存在争议。为阐明儿科结肠镜检查的基本原理，开展了本研究。
我们分析了21例结直肠息肉患者的结肠镜检查结果。患者平均年龄为3.7岁，年龄范围为1至7岁。10例患者可见直肠息肉：7例为单个息肉（6例为幼年性息肉，1例为腺瘤性息肉），3例为多发息肉（幼年性、淋巴样及黑斑息肉病合并增生性息肉）。10例患者可见乙状结肠息肉：均为单个幼年性息肉，但1例有腺瘤样改变。另1例患者整个结肠有多发黑斑息肉病息肉。16例患者行柔性结肠镜息肉切除术，4例患者行经肛门息肉切除术。2例幼年性息肉出现自截现象（1例反复自截最终行切除术）。息肉切除后，除1例黑斑息肉病综合征患者外，所有患者在6个月至15年期间均无复发。
大多数息肉位于直肠或乙状结肠。虽然大多数为单个或幼年性息肉，但由于儿科结肠息肉存在组织病理学多样性，对每个息肉进行组织病理学检查对于检测任何具有恶性潜能的发育异常或腺瘤性成分以及制定合适的随访计划很重要。有症状的息肉应在全身麻醉下行纤维结肠镜检查或经肛门切除并进行全结肠内镜检查。使用电凝圈套器和夹子进行息肉切除术有效且安全，使用聚乙二醇电解质溶液进行肠道准备对该手术而言足够。
