顾世松 吕珂 朱克东

[摘要] 目的 研究结肠及直肠息肉内镜下黏膜切除术（EMR）术中应用钛夹的效果及出血风险。 方法 选取2018年1月～2019年12月安徽省滁州市第一人民医院消化内科收治的结肠及直肠息肉患者50例作为研究对象，按照随机数表法将其分为观察组和对照组，每组25例。对照组行常规EMR，观察组在对照组的基础上应用金属钛夹。比较两组手术时间、术中出血量、肠鸣音恢复时间、排便疼痛视觉模拟（VAS）评分、排便困难评分、二次手术率及住院期间出血事件及并发症发生情况;比较两组术前及术后12 h血清皮质醇（COR）、肾上腺素（E）、去甲肾上腺素（NE）、多巴胺（DA）水平。 结果 观察组术中出血量、VAS评分及二次手术率均明显低于对照组，差异有统计学意义（P < 0.05）。与术前比较，两组术后COR、E、NE、DA升高，差異有统计学意义（P < 0.05）。两组间COR、E、DA比较，差异无统计学意义（P > 0.05），观察组术后NE低于对照组，差异有统计学意义（P < 0.05）。观察组出血发生率、并发症总发生率明显低于对照组，差异均有统计学意义（均P < 0.05）。 结论 结肠及直肠息肉EMR术中应用金属钛夹可较好的减轻术中及术后出血风险，能够降低术后并发症的发生率，有较高的临床意义。

[关键词] 结肠息肉;内镜下黏膜切除术;钛夹止血

[中图分类号] R574.62          [文献标识码] A          [文章编号] 1673-7210（2020）07（a）-0085-04

[Abstract] Objective To study the effect and bleeding risk of titanium clips in endoscopic mucosal resection （EMR） of colorectal polyps. Methods From January 2018 to December 2019， 50 patients with colonic and rectal polyps who admitted to the Department of Gastroenterology， the First People′s Hospital of Chuzhou were selected as the study objects. They were divided into the observation group and the control group according to the random number table method， with 25 cases in each group. Routine EMR was performed in the control group， while titanium clip was used in the observation group on the basis of the control group. The operation time， intraoperative bleeding volume， recovery time of bowel sounds， visual analogue scale （VAS） score of defecation pain， score of defecation difficulty， secondary operation rate and complications during hospitalization were compared between the two groups. The levels of cortisol （COR）， adrenaline （E）， noradrenaline （NE） and dopamine （DA） were compared before and 12 h after operation. Results The amount of bleeding， VAS score and the number of secondary operations in the observation group were significantly lower than those in the control group （P < 0.05）. Compared with pre-operation， the postoperative COR， E， NE and DA of the two groups were increased， and the difference was statistically significant （P < 0.05）. There was no statistically significant difference in COR， E， DA between the two groups （P > 0.05）. The postoperative NE of the observation group was lower than that of the control group， and the difference was statistically significant （P < 0.05）. The incidence of bleeding and complications in the observation group were significantly lower than those in the control group， and the differences were statistically significant （all P < 0.05）. Conclusion The application of titanium clip in EMR of colon and rectum polyp can reduce the risk of bleeding and the incidence of postoperative complications.

[Key words] Colonic polyp; Endoscopic mucosal resection; Hemostasis with titanium clip

结肠及直肠息肉作为一种癌前病变，恶变概率会随息肉的增大而不断升高，其发病机制为大肠黏膜各种局限性隆起而引发病变，在临床上属常见疾病。国外有学者认为腺瘤性息肉只需要10～15年的时间就能发展为大肠癌，且息肉直径≥2 cm的癌变概率为15%～50%，因此对结、直肠息肉的早期诊断及切除就成了预防癌变的首要方法[1-2]。随着近年来消化内镜在胃肠道疾病应用的不断普及，结肠息肉的发现率有了较大的提高，内镜下肠息肉切除术已成为治疗该疾病的有效方式，如内镜下黏膜切除术（EMR）目前已廣泛应用于临床，然而临床应用中也发现存在术中、术后出血的现象，且发生率较高[3-4]。……