董锦 姜中华 金星星 滕圣智 杨红梅

【摘要】 目的：觀察比较无蒂结直肠息肉患者经电子结肠镜下圈套器冷切除术治疗或氩离子束凝固术治疗的临床效果。方法：将2021年8月—2022年8月就诊于盐城市第一人民医院消化内科的150例无蒂结直肠息肉患者用随机数字表法进行对照探讨。对照组（n=75）给予电子结肠镜下氩离子束凝固术治疗，试验组（n=75）给予电子结肠镜下圈套器冷切除术治疗。比较两组手术时间、术中息肉切除时间、住院时间、息肉完整切除率、血清学指标[脂多糖（LPS）、C反应蛋白（CRP）、基质金属蛋白酶-2（MMP-2）]、术后并发症。结果：与对照组比较，试验组手术时间、术中息肉切除时间均更长，息肉完整切除率更低，差异均有统计学意义（P<0.05）。两组住院时间比较，差异无统计学意义（P>0.05）。术后72 h，两组LPS、CRP均升高，但试验组LPS、CRP均低于对照组，差异均有统计学意义（P<0.05）；术后72 h，两组MMP-2比较，差异无统计学意义（P>0.05）；试验组术后并发症发生率低于对照组，差异有统计学意义（P<0.05）。结论：电子结肠镜下圈套器冷切除术耗时长，但并发症较少，安全性相对更高，而氩离子束凝固术能够完整切除息肉，避免息肉残留。二者各有优势，建议临床根据患者需要选取最佳术式。

【关键词】 无蒂结直肠息肉 电子结肠镜 圈套器冷切除术 氩离子束凝固术

Comparison of the Effect of Cold Snare Polypectomy and Argon Plasma Coagulation under Electronic Colonoscope in the Treatment of Pediceless Colorectal Polyp/DONG Jin， JIANG Zhonghua， JIN Xingxing， TENG Shengzhi， YANG Hongmei. //Medical Innovation of China， 2024， 21（07）： 0-054

[Abstract] Objective： To observe and compare the clinical effects of patients with pediceless colorectal polyp treated by cold snare polypectomy or argon plasma coagulation under electronic colonoscope. Method： A total of 150 patients with pediceless colorectal polyp who were admitted to the Department of Gastroenterology， Yancheng NO.1 People's Hospital from August 2021 to August 2022 were compared and discussed according to random number table method. The control group （n=75） was treated with argon plasma coagulation under electronic colonoscope， and the experimental group （n=75） was treated with cold snare polypectomy under electronic colonoscope. The operation time， intraoperative polypectomy time， hospital stay， complete polypectomy rate， serological indexes [lipopolysaccharide （LPS）， C reactive protein （CRP）， matrix metalloproteinase-2 （MMP-2）] and postoperative complications were compared between the two groups. Result： Compared with the control group， the operative time and intraoperative polypectomy time of experimental group were longer， and the complete polypectomy rate was lower， the differences were statistically significant （P<0.05）. There was no significant difference in hospital stay between the two groups （P>0.05）. 72 h after operation， LPS and CRP were increased in both groups， but LPS and CRP in experimental groups were lower than those in control group， the differences were statistically significant （P<0.05）. 72 h after operation， there was no significant difference in MMP-2 between the two groups （P>0.05）. The incidence of postoperative complications in experimental group was lower than that in control group， the difference was statistically significant （P<0.05）. Conclusion： Cold snare polypectomy under electronic colonoscope takes a long time， but has fewer complications and relatively higher safety， while argon plasma coagulation can completely remove polyp and avoid polyp residue. Both have their own advantages， it is recommended to choose the best operation according to the needs of patients.

[Key words] Pediceless colorectal polyp Electronic colonoscope Cold snare polypectomy Argon plasma coagulation

First-author's address： Department of Gastroenterology， Yancheng NO.1 People's Hospital， Yancheng 224000， China

doi：10.3969/j.issn.1674-4985.2024.07.012

结直肠息肉源自肠黏膜上皮，属于一种隆起性病变，如果不及时切除，随着病情发展可能演变成结直肠癌[1]。电子结肠镜由于能够清晰显示出病变部位并指导临床精准切除息肉，已成为现代临床中一种备受推崇的内镜诊疗技术[2]。近年来，随着内镜技术日益提升，电子结肠镜下圈套器冷切除术（CSP）、氩离子束凝固术（APC）已成为结直肠息肉的常用术式[3-4]，但是对于无蒂结直肠息肉的治疗效果，尚缺乏大量报道。欧洲胃肠道内窥镜学会（ESGE）建议将电子结肠镜下CSP作为结直肠息肉治疗首选[5]，并且因为此种术式具备操作便捷、安全性高等特点，还建议将其作为5～10 mm无蒂结直肠息肉的主要治疗方法。……