何远琴?梁若玲?王丽萍?赖敏莉

[摘要] 目的 探究老年患者應用内镜下处理高级别瘤变肠息肉的临床疗效及其安全性。方法 回顾性分析我院2013年1月～2016年12月结直肠肿瘤术前病理确诊为结直肠高级别上皮内瘤变息肉且年龄>60岁的患者共75例，根据治疗方式的不同分为外科根治术组（n=36）和内镜摘除术组（n=39），外科根治术组患者行外科根治术，内镜摘除术组患者行内镜下息肉摘除术，统计两组患者总体术中情况、住院时间及术后并发症（如穿孔、出血、感染等）发生率。结果 两组所有患者均顺利完成手术，其中1例内镜摘除术组术中转为外科根治术。内镜摘除术组患者的平均住院时间、术中出血量、创口愈合时间明显短于外科根治术组患者的平均住院时间（P<0.01）；内镜摘除术组患者的术后并发症发生率（5.13%）均明显低于外科根治术组（25.00%），P<0.05。结论 内镜下处理高级别瘤变肠息肉疗效较外科手术切除临床疗效更好，且内镜摘除的方法术后并发症发生率更低，利于患者康复，且明显缩短住院时间，减少患者经济负担，是一种有效便捷且安全的治疗方法。

[关键词] 肠息肉高级别瘤变；内镜摘除术；术后并发症

[中图分类号] R574 [文献标识码] A [文章编号] 2095-0616（2017）14-191-03

Endoscopic treatment of high-grade neoplasms of senile intestinal polyps and its safety

HE Yuanqin1 LIANG Ruoling1 WANG Liping1 LAI Minli2

1. Department of Digestive System， Foshan Second People's Hospital， Foshan 528000， China； 2. Endoscopy Center， Foshan Second People's Hospital， Foshan 528000， China

[Abstract] Objective To explore the clinical efficacy and safety of endoscopic treatment of advanced tumorous intestinal polyps in elderly patients. Methods A total of 75 patients with colorectal neoplasms preoperative pathology diagnosed with colorectal high-grade intraepithelial neoplasia and age >60 years of age in our hospital from January 2013 to December 2016 were retrospective analyzed. They were divided into control group（n=36） and observation group（n=39） according to different treatment. Patients in the control group underwent surgical treatment. Patients in the observation group were treated with endoscopic polypectomy. The incidence of postoperative recovery， hospitalization and postoperative complications（such as perforation， bleeding， infection， etc.） were counted. Results All the patients in two groups were successfully completed. One case in observation groups was treated with surgical radical surgery. The average hospital stay， intraoperative blood loss and wound healing time in the endoscopic group were significantly shorter than in the patients undergoing radical surgery（P<0.05）. The incidence of postoperative complications（5.13%） in the observation group was significantly lower than that in the control group（25.00%）， P<0.05. Conclusion Endoscopic treatment of high-grade neoplasia of the treatment of polyps is better than the clinical efficacy of surgical resection， and endoscopic methods of postoperative complications has lower incidence. It is conducive to rehabilitation of patients. It is an effective and convenient and safe treatment

[Key words] High-grade neoplasm of intestinal polyps； Endoscopic surgery； Postoperative complications

肠息肉是一种肠黏膜表面异常隆起的病变，主要分为非腺瘤性息肉和腺瘤性息肉，包括炎症性息肉、增生性息肉、腺瘤性息肉和错构瘤性息肉[1]。而结直肠高级别上皮内瘤变（high-grade colorectal intraepithelial neoplasia，HFCIN）指结直肠黏膜上皮出现细胞学上和组织结构上的异型性变化，一旦这种异构化变化突破黏膜侵入黏膜下肌层，则成为结直肠癌，亦表明“腺瘤-癌”之间密切的演变关系[2]。且老年患者高级别瘤变肠息肉逐年增高，而老年患者因身体机能减退，身体康复能力减弱，而传统的开放性的手术根治外科手术常带来许多手术并发症，降低该病的治愈率[3]，随着现代医学的进步，内镜下治疗高级别瘤变肠息肉逐渐取代传统的开腹手术，现我院就传统外科手术与内镜下治疗高级别瘤变肠息肉临床疗效及并发症发生率等各方面比较，现报道如下。