无痛内镜下氩气刀切除胃肠息肉癌变患者的临床分析

摘要

目的：探讨无痛内镜下氩气刀切除与常规外科手术切除胃肠息肉癌变的临床效果差异。方法连续选取2012年2月至2014年2月入我院诊断为胃肠息肉癌变患者共162例（息肉198枚），所有患者均经内镜下息肉切除，病理证实为癌变。该研究取得我院伦理委员会通过及患者、家属的知情同意权后，将其分为对照组（75例）和试验组（87例），对照组患者经内镜下病理证实为癌病后转为外科手术治疗，试验组患者行无痛内镜下氩气刀切除息肉治疗，比较2组患者息肉切除率、手术时间、手术相关的并发症（如出血、穿孔、腹痛、腹胀、尿潴留等）发生率，随访1年后复查胃肠道内镜，比较2组患者的肿瘤复发率的差异性。结果2组患者息肉的山田分型和息肉切除率的比较，差异均无统计学意义（P＞0.05），试验组患者的手术时间显著少于对照组，差异有统计学意义（P＜0.05）。试验组患者的手术相关的并发症发生率显著低于对照组，差异有统计学意义（P＜0.05），术后腹胀者给予暂禁食；腹痛者给予抑制胃酸分泌和解痉治疗；出血者局部喷洒止血药；针对穿孔者行胃镜下钛夹夹闭治疗后痊愈。2组患者随访内镜下行病理分析肿瘤复发率差异无统计学意义（ P＞0.05）。结论采用无痛消化内镜下氩气刀切除癌变胃肠息肉，可以达到无痛治疗的目的，且创面损伤小，肿瘤复发率低，具有良好的治疗效果，值得推广。%Objective To study clinical effect differences of argon knife resection with painless endoscopy and common surgery for patients with gastrointestinal polyp canceration.Methods A total of 162 consecutives di‐agnosed as gastrointestinal polyp canceration from February 2012 to February 2014(198 polyp in all) were divided randomly into control group( n =75)and experiment group( n =87) .The patients in control group received com‐mon surgery after pathology proved with endoscopy .The patients in experiment group received argon knife resec‐tion with painless endoscopy .Then we compare differences of polyp resection rate ,operation time ,operation re‐lated complication(hemorrhage ,perforation ,abdominal pain ,abdominal distention and urinary retention inclu‐ding) ,the tumor recurrence rate after one year follow‐up .Results The Yamada type and resection rate of polyp in the two groups were of no statistical difference( P >0 .05) .The operation time and operation related complication rate in experiment group were both significantly lower than those in control group( P <0 .05) .The tumor recur‐rence rate in the two groups were of no statistical difference( P >0 .05) .Conclusion Argon knife resection with painless endoscopy for patients with gastrointestinal polyp canceration has certain safety and effectiveness .