外科理论与实践 ›› 2022, Vol. 27 ›› Issue (04): 351-356.doi: 10.16139/j.1007-9610.2022.04.015
韩华中1, 徐春华1, 范文阶1, 齐志鹏2, 李冰2, 周平红2, 姚礼庆2, 钟芸诗2, 陆品相1()
收稿日期:
2021-02-23
出版日期:
2022-07-25
发布日期:
2022-09-20
通讯作者:
陆品相
E-mail:2231243202@qq.com
基金资助:
HAN Huazhong1, XU Chunhua1, FAN Wenjie1, QI Zhipeng2, LI Bing2, ZHOU Pinghong2, YAO Liqing2, ZHONG Yunshi2, LU Pinxiang1()
Received:
2021-02-23
Online:
2022-07-25
Published:
2022-09-20
Contact:
LU Pinxiang
E-mail:2231243202@qq.com
摘要:
目的:探讨结肠直肠巨大息肉内镜黏膜下剥离术,留置肛管减压对术后恢复和预防术后并发症发生的临床意义。方法:设计前瞻性临床随机对照研究。入组结肠直肠巨大息肉(直径≥3 cm)的病人,分为内镜治疗组100例和内镜治疗加预防性肛管置入组(简称内镜肛管组)92例,比较两组术后恢复和并发症发生率。结果:内镜治疗组术后发生迟发性出血5例(5.0%),内镜肛管组2例(2.2%);内镜治疗组术后发生电凝综合征7例(7.0%),内镜肛管组发生1例(1.1%)。两组术后并发症发生的差异有统计学意义,P<0.05。术后3 d内镜治疗组平均体温(37.2±0.8) ℃,内镜肛管组平均体温(37.1±0.6)℃,两组体温差异无统计学意义。内镜肛管组的肠蠕动恢复时间(22.5±5.9) h与内镜治疗组(39.3±10.4) h的差异有统计学意义,P<0.01。内镜肛管组腹痛程度评分(2.2±1.3)分与内镜治疗组(4.7±2.2)分的差异有统计学意义,P<0.01。术后第一天腹部平片显示,内镜治疗组的肠腔较内镜肛管组明显扩张。结论:内镜黏膜下剥离结肠直肠巨大息肉术后,应用肛管减压引流是一种简单有效的预防措施,有术后恢复好,并发症发生率低的临床意义。
中图分类号:
韩华中, 徐春华, 范文阶, 齐志鹏, 李冰, 周平红, 姚礼庆, 钟芸诗, 陆品相. 内镜切除结肠直肠巨大息肉术后留置肛管减压的研究[J]. 外科理论与实践, 2022, 27(04): 351-356.
HAN Huazhong, XU Chunhua, FAN Wenjie, QI Zhipeng, LI Bing, ZHOU Pinghong, YAO Liqing, ZHONG Yunshi, LU Pinxiang. Study on transanal tube drainage after endoscopic resection of giant colorectal polyp[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 351-356.
表1
两组一般资料比较[$\bar{x} \pm s$)/n(%)]
项目 | 内镜肛管组 (n=92) | 内镜治疗组 (n=100) | t值 | P值 |
---|---|---|---|---|
病变位置 | ||||
右半结肠 | 19(20.7) | 22(22.0) | ||
左半结肠 | 23(25.0) | 27(27.0) | ||
直肠 | 50(54.3) | 51(51.0) | ||
病变直径(cm) | 4.0±0.9 | 3.9±0.9 | -0.05 | 0.96 |
术中穿孔 | 2a) | 0 | ||
术后并发症 | 3 | 12 | 17 | 0.04 |
迟发性出血 | 2(2.2) | 5(5.0) | ||
电凝综合征 | 1(1.1) | 7(7.0) | ||
术后3 d的体温(℃) | 37.1±0.6 | 37.2±0.8 | 0.5 | 0.7 |
肠蠕动恢复时间(h) | 22.5±5.9 | 39.3±10.4 | 13.7 | <0.01 |
腹痛程度评分(分) | 2.2±1.3 | 4.7±2.2 | 9.5 | <0.01 |
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