【摘要】：目的:探討氬離子凝固術(shù)聯(lián)合金屬鈦夾在大腸息肉電切除術(shù)中的應用價值,并正確評價其治療優(yōu)勢與效果。方法:選取我院2015年1月-2015年12月結(jié)腸息肉行內(nèi)鏡下治療的患者415例,分成A、B、C三個治療組,其中A組為應用高頻電凝電切術(shù)后單純氬離子凝固術(shù)處理創(chuàng)面治療大腸息肉組147人,男性患者91例,女性患者56例,年齡31~80歲,其中60歲以下85人,60歲及以上62人;B組為應用高頻電凝電切術(shù)后金屬鈦夾夾閉創(chuàng)面治療大腸息肉組133人,男性患者79例,女性患者54例,年齡35~84歲,其中60歲以下76人,60歲及以上57人;C組為應用高頻電凝電切術(shù)后氬離子凝固術(shù)聯(lián)合金屬鈦夾夾閉創(chuàng)面治療大腸息肉組135人,男性患者83例,女性患者52例,年齡33~79歲,其中60歲以下72人,60歲及以上63人。采用SPSSX~2檢驗方法對415例患者進行分析,分別計算上述三種方法治療后出現(xiàn)的并發(fā)癥,包括腹脹、腹痛、穿孔率和出血率,并對隨訪的三組患者觀察治愈率及復發(fā)率,結(jié)合臨床資料對氬離子凝固術(shù)聯(lián)合金屬鈦夾在大腸息肉切除術(shù)中的作用與效果進行評估。結(jié)果:415例患者,三組所有病例術(shù)中術(shù)后穿孔率均為0,A組患者腹脹、腹痛發(fā)生率約21.8%;B組患者腹脹、腹痛發(fā)生率約15.8%;C組患者腹脹、腹痛發(fā)生率約12.6%。C組腹脹、腹痛發(fā)生率低于A組和B組,經(jīng)過X~2檢驗統(tǒng)計學比較三組數(shù)值,X~2=4.388,p=0.111,p0.05,無差異,不具有統(tǒng)計學意義。A組患者出血發(fā)生率約8.16%,B組患者出血發(fā)生率約3.01%,C組患者出血發(fā)生率約2.22%,經(jīng)過X~2檢驗統(tǒng)計學比較三組數(shù)值,X~2=6.791,p=0.034,p0.05,差異具有統(tǒng)計學意義。經(jīng)過X~2檢驗統(tǒng)計學比較A組與C組出血并發(fā)癥,X~2=4.932,p=0.026,差異有統(tǒng)計學意義(p0.05)。以上三組中出現(xiàn)出血的患者,使用急診結(jié)腸鏡下氬離子凝固術(shù)聯(lián)合鈦夾對出血創(chuàng)面再次處理后均未再出血。隨訪6個月后,三組患者中A組32例患者,復發(fā)4例,復發(fā)率為12.50%;B組26例患者,復發(fā)8例,復發(fā)率為30.77%;C組45例患者,復發(fā)4例,復發(fā)率為8.89%。通過X~2檢驗三組結(jié)果,X~2=6.338,p=0.042,差異有統(tǒng)計學意義(p0.05)。結(jié)論:氬離子凝固術(shù)聯(lián)合鈦夾電切治療大腸息肉,術(shù)中及術(shù)后出現(xiàn)并發(fā)癥可能性低,一次性切除率高,總治愈率高,復發(fā)率低。在大腸息肉治療中氬離子凝固術(shù)聯(lián)合鈦夾可有效預防術(shù)中及術(shù)后并發(fā)癥的發(fā)生,具有安全、有效及不易復發(fā)等臨床特點。
[Abstract]:Objective: to evaluate the value of argon ion coagulation combined with titanium clip in electroresection of colorectal polyps. Methods: 415 patients with colonic polyps treated by endoscope from January 2015 to December 2015 in our hospital were divided into three groups: group A was treated with argon ion coagulation only after high frequency electrocoagulation. There were 91 male patients and 56 female patients aged 31 to 80 years. Among them, 85 patients under 60 years old and 62 patients over 60 years old were treated with metal titanium clip clamping wound after high frequency electrocoagulation for treatment of large intestinal polyp in 133 cases, male patients in 79 cases. 54 female patients, aged 35 to 84 years, including 76 patients under 60 years old and 57 patients over 60 years old, group C were treated with argon ion coagulation after high frequency electrocoagulation combined with metal titanium clip clamping wound in 135 patients with colorectal polyps, 83 male patients. There were 52 female patients aged 3379 years, including 72 patients under 60 years old and 63 patients over 60 years old. The complications, including abdominal distension, abdominal pain, perforation rate and bleeding rate, were calculated by SPSSX~2 test in 415 patients, and the cure rate and recurrence rate were observed. Combined with clinical data, the effect of argon ion coagulation combined with titanium clip in resection of colorectal polyp was evaluated. Results among 415 patients, the rate of perforation in all the three groups was abdominal distension in group A, the incidence of abdominal pain in group B was about 21.8B, the incidence of abdominal pain was about 15.8% in group C, and the incidence of abdominal pain in group C was about 12.6%. The incidence of abdominal pain in group A and group B was lower than that in group A and group B. there was no difference between the three groups by X2 test. The incidence of bleeding in group B was about 3.01%. The incidence of bleeding in group C was about 2.22%. After X2 test, the three groups were compared with each other by X2 test. The difference was statistically significant. The bleeding complications of group A and group C were compared statistically by X2 test. The difference was statistically significant (p0.05). The bleeding patients in the above three groups were treated with argon ion coagulation and titanium clip under emergency colonoscopy. After 6 months follow-up, there were 32 patients in group A, 4 patients in group A, 26 patients in group B with a recurrence rate of 12.50, 8 patients in group B, 45 patients in group C with a recurrence rate of 30.777am C, 4 patients in group A with a recurrence rate of 8.89. The results of the three groups were tested by X2, and the difference was statistically significant (p0.05). Conclusion: argon ion coagulation combined with titanium clip electrolysis for the treatment of colorectal polyps has a low possibility of complications during and after operation, a high rate of one-off resection, a high total cure rate and a low recurrence rate. Argon ion coagulation combined with titanium clip can effectively prevent intraoperative and postoperative complications in the treatment of colorectal polyps. It is safe, effective and difficult to recur.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656

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