内镜下切除大型有蒂结肠息肉，肾上腺素注射与圈套器和止血夹相比预防息肉切除术后出血的风险：一项前瞻性、随机研究。
Endoscopic resection of large pedunculated colonic polyps and risk of postpolypectomy bleeding with adrenaline injection versus endoloop and hemoclip: a prospective, randomized study.
机构信息
Endoscopy Unit, Demokritus University of Thrace, Draganaa, 68100 Alexandroupolis, Greece.
出版信息
Surg Endosc. 2009 Dec;23(12):2732-7. doi: 10.1007/s00464-009-0478-3. Epub 2009 May 9.
BACKGROUND
Postpolypectomy bleeding is a major complication, especially in large pedunculated colonic polyps. Several endoscopic techniques have been evolved for prevention of bleeding episodes. The aim of this study is to evaluate postpolypectomy bleeding rates in large (>2 cm) pedunculated colonic polyps using either adrenaline injection alone or loop and clip application as prophylactic methods.
MATERIALS AND METHODS
Patients with one pedunculated colonic polyps (>2 cm) were included in a double-blind study and studied prospectively. Exclusion criteria were coexistence of other large polyps, antiplatelet, nonsteroidal anti-inflammatory drugs or aspirin. In group A (n = 32), adrenaline (1:10,000) was injected in the base of the stalk followed by conventional polypectomy using mixed coagulation and cutting current. In group B (n = 32), a detachable snare was placed at the base of the stalk followed by conventional polypectomy and clip application in the residual stalk above the snare. We evaluate the efficacy of combined endoscopic methods in early and late postpolypectomy bleeding rate in large pedunculated colonic polyps, severity of bleeding, days of hospitalization, and required transfusions.
RESULTS
Overall, bleeding complications occurred in 5/64 patients (7.81%). In group A (adrenaline injection alone), four patients (12.5%) had a bleeding episode: two (6.25%) occurred during the first 24 h and two (6.25%) between days 7 and 14 from the procedure. In group B only one patient (3.12%) had a late bleeding episode (p = 0.02). Severity of late bleeding in group B patients (one moderate bleeding) versus group A patients (one moderate and one severe bleeding) and need for transfusions (1 versus 5 blood units) were lower (p = 0.02). Hospitalization days did not differ between the two groups, but colonoscopy time was significantly higher in group B versus group A (p = 0.04).
CONCLUSION
Combined endoscopic techniques seem to be more effective in preventing postpolypectomy bleeding in large pedunculated colonic polyps.
背景
息肉切除术后出血是一种主要的并发症，尤其是在大型有蒂结肠息肉中。已经开发出几种内镜技术来预防出血事件。本研究的目的是评估单独使用肾上腺素注射或圈套和夹应用作为预防性方法治疗大型 (>2 cm) 有蒂结肠息肉切除术后出血的发生率。
材料和方法
将患有单个有蒂结肠息肉 (>2 cm) 的患者纳入一项双盲前瞻性研究。排除标准为同时存在其他大息肉、抗血小板药物、非甾体抗炎药或阿司匹林。在 A 组（n = 32）中，在蒂部基底注射肾上腺素（1:10,000），然后使用混合凝固和切割电流进行常规息肉切除术。在 B 组（n = 32）中，在蒂部放置可分离的圈套器，然后在圈套器上方的蒂部残留部分进行常规息肉切除术和夹闭。我们评估了联合内镜方法在大型有蒂结肠息肉中早期和晚期息肉切除术后出血率、出血严重程度、住院天数和所需输血方面的疗效。
结果
总体而言，64 例患者中有 5 例（7.81%）发生出血并发症。在 A 组（单独肾上腺素注射）中，有 4 例（12.5%）发生出血事件：2 例（6.25%）发生在术后 24 小时内，2 例（6.25%）发生在术后第 7 至 14 天。在 B 组中，仅 1 例（3.12%）发生迟发性出血（p = 0.02）。B 组患者（1 例中度出血）的迟发性出血严重程度与 A 组患者（1 例中度和 1 例重度出血）以及需要输血的情况（1 与 5 单位血液）均较低（p = 0.02）。两组患者的住院天数无差异，但 B 组的结肠镜检查时间明显长于 A 组（p = 0.04）。
结论
联合内镜技术似乎在预防大型有蒂结肠息肉切除术后出血方面更有效。
Zotero 插件