外科理论与实践

外科理论与实践 >

2022 , Vol. 27 >Issue 04: 351 - 356

DOI: https://doi.org/10.16139/j.1007-9610.2022.04.015

论著

内镜切除结肠直肠巨大息肉术后留置肛管减压的研究

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  • 1.上海市徐汇区中心医院普外科 内镜中心,上海 200031
    2.复旦大学附属中山医院内镜中心 上海消化内镜诊疗工程技术研究中心,上海 200032

收稿日期: 2021-02-23

  网络出版日期: 2022-09-20

基金资助

上海市科学技术委员会项目(16411950407);上海市科学技术委员会项目(19511121303);徐汇区医学科技项目(SHXH201604)

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Study on transanal tube drainage after endoscopic resection of giant colorectal polyp

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  • 1. Department of General Surgery, Endoscopy Center, Xuhui District Central Hospital, Shanghai 200031, China
    2. Endoscopy Center, Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Received date: 2021-02-23

  Online published: 2022-09-20

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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。

关键词： 结肠直肠巨大息肉; 内镜黏膜下剥离术; 肛管减压; 术后迟发性出血; 电凝综合征

本文引用格式

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 . DOI: 10.16139/j.1007-9610.2022.04.015

Abstract

Objective To investigate the clinical effect of transanal tube drainage and anal decompression after endoscopic submucosal dissection (ESD) of giant colorectal polyp for postoperative recovery and the prevention of complication. Methods Prospective clinical randomized control study was done. Enrolled patients with giant colorectal polyps (diameter ≥3 cm) were divided into 100 cases in endoscopic treatment group(endoscopic group) and 92 cases in endoscopic treatment with prophylactic anal tube implantation group (endoscopic anal tube group). Postoperative recovery and complication between 2 groups were compared. Results Delay bleeding from anal of postoperative complications was present 5(5.0%) cases in endoscopic group and 2(2.2%) cases in endoscopic anal tube group. There were electrocoagulation syndrome of complications 7 (7.0%) cases in endoscopic group and 1(1.1%) case in endoscopic anal tube group. The difference in postoperative complication rate was significant statistically(P<0.05). The temperature 3 days after surgery of patients in endoscopic group and endoscopic anal tube group was (37.2±0.8) ℃ and (37.1±0.6) ℃, respectively without significant diffe-rence (P>0.05) between two groups. Intestinal peristalsis returned (22.5±5.9) h after operation in endoscopic anal tube group and (39.3±10.4) h in endoscopic group with statistically significant differences (P<0.01) between two groups. Abdominal pain score was (2.2±1.3) in endoscopic anal tube group, which was lower than that (4.7±2.2) in endoscopic group statistical significantly (P<0.01). On the first day after operation, intestinal cavity of endoscopic group expanded significantly more compared with that of endoscopic anal tube group by abdominal plain radiograph. Conclusions Anal decompression and drainage after ESD of giant colorectal polyp could be simple and safe preventive measures with low rate of postoperative complications and better recover which would be worth use during ESD.

Key words： Giant colorectal polyp; Endoscopic submucosal dissection; Anal decompression; Postoperative delay bleeding; Electrocoagulation syndrome

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