Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan.
Digestion. 2011;84(1):78-81. doi: 10.1159/000323959. Epub 2011 Apr 14.
The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms.
Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group). The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding.
Eighty patients were randomized: cold group, n = 40 (101 polyps) and conventional group, n = 40 (104 polyps). The patients' demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. conventional polypectomy (18 vs. 25 min, p < 0.0001). Complete polyp retrieval rates were identical [96% (97/101) vs. 96% (100/104)]. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy (i.e. 20%; 8/40) than with cold polypectomy (i.e. 2.5%; 1/40; p = 0.029).
Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms. The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps.
目前，对于直径小于 8mm 的结直肠小息肉，仍没有一种理想的切除方法。本研究旨在比较冷圈套息肉切除术（冷切除术）与传统电切圈套息肉切除术（热切除术）在操作时间、息肉取出难易程度、出血及术后症状等方面的差异。
将直径小于 8mm 的结直肠息肉患者随机分为冷圈套息肉切除术组（冷切组，n=40，共 101 枚息肉）和传统电切圈套息肉切除术组（热切组，n=40，共 104 枚息肉）。主要观察指标为术后 2 周内的腹部症状。次要观察指标为息肉的回收率和出血率。
80 例患者被随机分为两组，冷切组 40 例（101 枚息肉），热切组 40 例（104 枚息肉）。两组患者的一般资料、息肉数量和大小相似。与热切组相比，冷切组的操作时间明显缩短（18 分钟 vs. 25 分钟，p<0.0001）。两组的完全息肉回收率相同[96%（97/101）vs. 96%（100/104）]。两组均无需要止血的出血病例。热切组术后腹痛症状更常见（20%，8/40），冷切组少见（2.5%，1/40），差异有统计学意义（p=0.029）。
与传统电切圈套息肉切除术相比，冷圈套息肉切除术在操作时间和术后腹痛症状方面具有优势。两种方法在出血风险和完全息肉回收率方面基本相同。因此，冷圈套息肉切除术是切除小的结直肠息肉的首选方法。
