本文關鍵詞： 氣囊輔助內(nèi)鏡 小腸息肉 鏡下息肉切除 回顧性分析　出處：《安徽醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的：研究氣囊輔助內(nèi)鏡(BAE)在小腸息肉治療中的應用,探討其作為小腸疾病治療方法的可行性、安全性及臨床價值。方法： 回顧性總結中國人民解放軍空軍總醫(yī)院消化內(nèi)科白2006年8月至2014年7月臨床收治的199例小腸息肉患者的臨床資料,包括一般資料如年齡、性別、手術史、家族病史、首發(fā)癥狀等；199例患者進行氣囊輔助內(nèi)鏡檢查及內(nèi)鏡下息肉切除治療情況：進鏡途徑、進鏡深度、檢查次數(shù)、鏡下切除小腸息肉的數(shù)目、形態(tài)、大小及組織病理學結果等；術后并發(fā)癥和對并發(fā)癥的處理情況。對其中32例忠者,進行BAE治療與于術治療的住院費用、住院時間及術后胃腸動力恢復時間的比較。評價氣囊輔助內(nèi)鏡作為小腸息肉治療方式的可行性、安全性及臨床應用價值。所有數(shù)據(jù)使用SPSS 19.0進行統(tǒng)計分析。結果：1.199例小腸息肉患者中男性110例,女性89例,包括Peutz-Jeghers綜合征患者179例,家族性腺瘤性息肉病3例及其他空回腸息肉患者17例。2.199例患者共進行558例次氣囊輔助內(nèi)鏡檢查及治療,內(nèi)鏡下治療切除小腸息肉共3391枚,其中直徑5-10mmm 801枚(23.62%),11-30mm 1887枚(55.65%),31-50mm 563枚(16.60%),大于50mmm 140枚(4.13%),最大者約為7cm*10cm。有蒂及亞蒂息肉2945枚(86.84%),無蒂及廣基息肉446枚(13.16%)。199例患者中,有5例發(fā)生息肉癌變,其中2例有淋巴結轉(zhuǎn)移,1例腹腔及肝臟轉(zhuǎn)移。3.術后發(fā)生一過性的輕微腹痛、腹部不適、惡心、嘔吐等不適癥狀者437例次,發(fā)生率為78.32%,21例次(3.76%)發(fā)生術后并發(fā)癥,其中15例次術后息肉殘根出血,12例經(jīng)內(nèi)科止血藥物保守治療后出血停止,2例再次進鏡行內(nèi)鏡下止血治療后出血停止,1例保守治療無效轉(zhuǎn)外科手術止血治療。6例息肉鏡下切除術后發(fā)生即時或延遲腸穿孔,經(jīng)外科手術修補痊愈。無手術相關死亡病例發(fā)生。4.對32例患者進行外科手術治療和BAE治療的住院天數(shù)、住院費用及術后恢復時間進行配對樣本t檢驗,P0.01,具有統(tǒng)計學意義,說明兩種治療方法存在差異。結論：BAE是一種行之有效的小腸息肉治療方法,其突出的優(yōu)點是可反復多次進行,尤其對多發(fā)息肉者可通過多次鏡下治療以將息肉全部切除,而且術后并發(fā)癥少,較之外科手術具有創(chuàng)傷小,安全性較高,治療成本較低的優(yōu)勢。對大多小腸息肉患者,可替代外科手術而作為首選治療方法,具有較好的臨床應用價值及發(fā)展前景。
[Abstract]:Objective: to study the application of balloon assisted endoscopy (BAE) in the treatment of intestinal polyps, and to explore the feasibility of using BAE as a treatment method for intestinal diseases. Safety and clinical value. Methods:. The clinical data of 199 cases of small intestinal polyps treated from August 2006 to July 2014 in the Department of Digestive Medicine, Air Force General Hospital of the Chinese people's Liberation Army (PLA) were retrospectively summarized. Including general data such as age, sex, surgical history, family history, initial symptoms and so on; 199 patients underwent balloon assisted endoscopy and endoscopic polyposectomy: approach, depth, times of examination, number and shape of small intestinal polyps resected under endoscope. Size and histopathological results; Postoperative complications and management of complications. 32 of them were treated with BAE and the cost of hospitalization. To evaluate the feasibility of balloon assisted endoscopy in the treatment of intestinal polyps. All the data were analyzed by SPSS 19.0. Results 110 cases were male and 89 cases were female in 1. 199 cases of small intestinal polyps. Including 179 patients with Peutz-Jeghers syndrome. 3 cases of familial adenomatous polyposis and 17 cases of other jejunal polyps were treated with balloon assisted endoscopy. A total of 3391 small intestinal polyps were treated by endoscopy, of which 801 of 5-10 mm in diameter were treated with 23.62% of them (11-30 mm, 1887 pieces, 55.65). 31-50 mm 563 pieces with 16.60 pieces, more than 50 mm and 140 pieces with 4.13). The largest was about 7 cm ~ (10) cm. There were 2945 pedicle and subpedicle polyps (86.84), 446 without pedicle and broad base polyps (13.16%) in 199 cases. There were 5 cases of polyp carcinogenesis, of which 2 cases had lymph node metastasis 1 case had abdominal and liver metastasis .3.After operation, 437 cases had temporary abdominal pain, abdominal discomfort, nausea, vomiting and other discomfort symptoms. The incidence of postoperative complications was 78.3232 and 21 cases (3.76). Among them, 15 cases had bleeding of residual root of polyps and 12 cases had stopped bleeding after conservative treatment with medical hemostatic drugs. 2 cases received endoscopic hemostasis after hemostasis and 1 case was retreated with conservative treatment and surgical hemostasis. 6 cases occurred immediate or delayed intestinal perforation after polyposcopy resection. No operation-related deaths occurred. 32 patients were treated with surgical treatment and BAE for days in hospital. The cost of hospitalization and postoperative recovery time were tested by paired t-test (P0.01), which was statistically significant. Conclusion the two methods are effective for the treatment of small intestinal polyps, the outstanding advantage of which is that they can be carried out over and over again. Especially for the patients with multiple polyps, the polyps can be completely resected through multiple endoscopy, and the complications are less, compared with surgery, the trauma is less and the safety is higher. For most of the patients with small intestinal polyps, it can be used as the first choice instead of surgery, which has good clinical application value and development prospect.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R656.7

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