| BackgroundColorectal polyps are a common digestive disease,mostly due to excessive growth of epithelial cells,leading to large intestinal mucosal uplift and protrude into the intestine.The cause of the disease is not yet clear,may be caused by familial factors,hereditary factors,inflammatory hyperplasia or other factors such as environment and diet together.Colorectal polyps are occult in onset,and the early symptoms of patients often are not typical.Most people see a doctor due to abdominal distension,hematochezia and other symptoms,and the colorectal polyps are found by colonoscopy.Colorectal polyps can be divided into non-adenomatous polyps and adenomatous polyps on histology.The non-adenomatous polyps consist to hyperplastic polyps,inflammatory polyps,juvenile polyps and hamartoma,and the other mainly consist of tubular adenoma,villous adenoma and tubular villous adenoma.In recent years,the study found that the proportion of adenomatous polyps canceration as high as 2.9%-9.4%.The malignant transformation mainly occurs within 10 years.And then all non-adenomatous polyps can be differentiated into adenomatous ones.It can be seen that all colorectal polyps may transform into colorectal cancer.Now it is advocated that colorectal polyps should be found early,should be diagnose early,should be treat early,in order to early block “non-adenomatous polyps – adenomatous polyps – colorectal cancer” this evolution process and prevent the growth of cancer.In the past,surgical resection is the preferred treatment for colorectal polyps,but it always has some disadvantages,and patients must suffer big trauma,cost a lot,and recover slowly.With the development of endoscopy technology,endoscopic polypectomy has been replaced surgery,used widely in the clinical practice.The common endoscopy treatment technology consist to laser,freezing,microwave,alcohol injection,endoscopic high-frequency electrocoagulation,argon plasma coagulation(APC)and so on.The most common way is endoscopic high-frequency electrocoagulation.With the development of technology,on the base of endoscopic high-frequency electrocoagulation,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD)and many other new treatment technique developed,giving us more choices in the colonoscopic treatment and making colonoscopic treatment of colorectal polyps more diversified.They also can make colonoscopic treatment safer and more effective theoretically.Pure high-frequency electrocoagulation is one of the earliest endoscopy treatment technology for colorectal polyps.This method can make the surface of tissue dry and coagulated by the spark discharge between the gap of high frequency electrode and tissue.EMR includes submucosal injection-resection,transparent-cap technique,ligature technique,dual-channel endoscopy.The submucosal injection-resection is the most common and the simplest EMR technique,also used in our research.The submucosal injection-resection separates mucosa and muscular layer through endoscopic injection in order to avoid damage to the blood vessels,muscular layer and lower tissue and reduce the bleeding,perforation and other complications when treating colorectal polyps.The method that pure high-frequency electrocoagulation resection combined with nylon trap surgery or mental titanic clips can use nylon rope or mental titanic clip to block the blood supply to the root of colorectal polyps,and treat the polyps in pure high-frequency electrocoagulation resection after that.This method can reduce the incidence of complications such as bleeding.Now,the incidence rate of colorectal polyps increases year by year,which requires us to recognize the colorectal polyps deeply and to understand the clinical characteristics of colorectal polyps.More and more patients with colorectal polyps undergo colonoscopic treatment.Safety is becoming more and more important under effectiveness.Bleeding and perforation are the common complication of colonoscopic treatment at present,so the problem that how to minimize the occurrence of these complications get more and more attention.This prompts us to put the safety of colonoscopic treatment into the operational treatment.It is an arduous and important task to choose safer and more appropriate methods.Objective:1.To understand the clinical features of colorectal polyps in different parts,by analyzing patients' age and gender,the characteristic of colorectal polyps,such as shape,size,pathological type,incidence of complications.2.To explore the relationship between the safety of colonoscopic treatment and the size,shape,location of colorectal polyps,by analyzing the incidence of complications of colonoscopic treatment of colorectal polyps in different size,different shapes and different parts.3.To explore the safety of colonoscopic treatment and whether the submucosal injection-resection is superior to pure high-frequency electrocoagulation resection,by analyzing the complication rate of colonoscopic treatment of colorectal polyps without long thick peduncle.4.To explore the safety of colorectal polyps with long thick peduncle treated with endoscope and to understand the role of pretreatment such as nylon trap surgery and mental titanic clips in the colonoscopic treatment of colorectal polyps with long thick peduncle,by analyzing the complication rate of colonoscopic treatment of colorectal polyps with long thick peduncle(>5mm).Methods:Retrospective analysis the patients,with colorectal polyps,accepted endoscopic resection in the First Affiliated Hospital of Guangzhou Medical University during January 2008 and January 2014.There are 837 patients in our study,and 1135 polyps were checked in 837 cases.We use SPSS 13.0 statistical software for data processing.1.According to location,colorectal polyps are divided into three groups,that is: right colon group,left colon group,rectum group.To analyze whether there are differences in patients' gender,age and size,shape,pathological type of polyps among the three groups.2.According to size,colorectal polyps are divided into two groups,that is: small polyp group(diameter ? 10mm),large polyp group(diameter > 10mm).According to shape,colorectal polyps are divided into three groups,that is: sessile polyp group,polypus group,pedunculated polyp group.According to location,colorectal polyps are divided into three groups,that is: right colon group,left colon group,rectum group.To analyze whether there are differences in complication rate of colonoscopic treatment among the groups of different sizes,shapes,locations respectively.3.Total 1135 polyps were treated with endoscope.Sessile polyps and polypus,5mm smaller in diameter,were removed with biopsy forceps or APC.Other polyps were removed with endoscopic electroexcision,consists of method A,method B and method C.Method A is pure high-frequency electrocoagulation resection.Method B is submucosal injection-resection,one of EMR technique,using submucosal injection of noradrenaline solution(1:10000)before high-frequency electrocoagulation resection.Method C is using nylon trap surgery or mental titanic clips before high-frequency electrocoagulation resection,which is used to remove colorectal polyps with long thick peduncle.According to the different ways of endoscopic electroexcision,colorectal polyps without long thick peduncle were divided into two groups,method A group and method B group.Pretreated before electroexcision,colorectal polyps without long thick peduncle were divided into two groups,method B group and method C group.To analyze whether there are differences in complication rate of different endoscopic electroexcision.Results:1.Comparison of clinical features of polyps in different parts of large intestine: compared with left colon group,right colon group and rectum group,there is no statistically significant differences in patients' gender(P>0.05).Male is more than female,and the ratio of male to female is 1.5: 1.Compared with the three groups,there are statistically significant differences in patients' age(P<0.05).More than 60 years old patients are the most in the right and left colon group,but in the rectum group,the middle-aged patients aged from 40 to 60 years old is the most.Colorectal polyps mainly occur in the elderly on the whole.Compared with the three groups,there are statistically significant differences in size,shape and pathological type(P<0.05).Sessile-small polyps are the most in the three groups.But the proportion of sessile polyps in right colon and rectum group is higher than left colon group.And then in the right colon and rectum group,the polyps,5mm smaller in diameter,is the most.The average size of polyps in the right colon and rectum group should be smaller than the left colon.Adenomatous polyps,especially tubular adenomas are the most in the three groups.The ratio of adenomatous polyps to non-adenomatous ones is 3: 1 in right and left colon group,and adenomatous polyps significantly more than non-adenomatous ones.2.Compared with small polyp group and large polyp group,there are statistically significant differences in the complication rate of colonoscopic treatment(P<0.05).The rate of postpolypectomy bleeding(PPB)in the large polyp group is higher than the small polyp group.Compared with sessile polyp group,polypus group,pedunculated polyp group,there are statistically significant differences in the complication rate of colonoscopic treatment(P<0.016).The rate of PPB in the pedunculated polyp group is the highest,and the rate of PPB in the sessile polyp group is the lowest.Compared with right colon group,left colon group,rectum group,there are no statistically significant differences in the complication rate of colonoscopic treatment(P>0.05),the rate of PPB in which is 3%.3.Total 1135 polyps were treated with endoscope.The total rate of PPB is 3.08%(35/1135),including 35 polyps with immediate postpolypectomy bleeding(IPPB)and 0 polyps with delayed postpolypectomy bleeding(DPPB).And there are no hemorrhea,no enterobrosis.There are 461 polyps were removed with biopsy forceps or APC and 674 polyps were removed with endoscopic electroexcision.There is no complication in those polyps removed with biopsy forceps or APC.Immediate postpolypectomy bleeding(IPPB)appeared in 35 polyps removed with endoscopic electroexcision.4.Compared with method A group and method B group,there are statistically significant differences in the complication rate of colorectal polyps without long thick peduncle(P<0.05).631 colorectal polyps without long thick peduncle were removed with endoscopic electroexcision,28 polyps of that occurred IPPB(4.4%).188 polyps were adopted method A,and the rate of IPPB is 10.6%.443 polyps were adopted method B,and the rate of IPPB is 1.8%.The rate of IPPB in method B group is lower than method A group.The odds ratio(OR)of the IPPB in the method A group is 6.47,and the 95% CI of OR is 2.797-14.980.The risk of using pure high-frequency electrocoagulation resection is 6.47 times higher than using submucosal injection-resection.5.Compared with method B group and method C group,there are statistically significant differences in the complication rate of colorectal polyps with long thick peduncle(P<0.05).43 colorectal polyps with long thick peduncle were removed with endoscopic electroexcision,7 polyps of that occurred IPPB(16.3%).18 polyps were adopted method B,and the rate of IPPB is 33.3%(6/18).25 polyps were adopted method C,and the rate of IPPB is 4%(1/25).The rate of IPPB in method C group is lower than method B group.The odds ratio(OR)of the IPPB in the method B group is 11.9,and the 95% CI of OR is 1.294-111.323.For the colorectal polyps with long thick peduncle,the risk of using submucosal injection-resection is 11.9 times higher than high-frequency electrocoagulation resection combined with nylon trap surgery or mental titanic clips.Conclusion:1.The location of colorectal polyps has nothing to do with the patients' gender,but it is related to patients' age.The incidence of colorectal polyps increases with age.The right and left colon polyps mainly occur in elderly patients,but the rectum polyps mainly occur in middle-aged patients.No matter which part of the colorectal polyps,sessile-small polyps and adenomatous polyps are the most.Once colorectal polyps are found,it should be removed as soon as possible in order to prevent malignant transformation.2.The safety of colonoscopic treatment is related to shape,size of colorectal polyps.Large polyps and polyps with long thick peduncle occur complications more easily.And the safety of colonoscopic treatment has nothing to do with the location of colorectal polyps.No matter where the colorectal polyps are,they can be removed with colonoscopic treatment,if we use appropriate technique.3.For sessile-small colorectal polyps,removing with biopsy forceps or APC is the most effective,most convenient,and safest method.4.For colorectal polyps without long thick peduncle,submucosal injectionresection is safer and more complete than pure high-frequency electrocoagulation resection,which can effectively reduce the complication rate of colonoscopic treatment.Submucosal injection-resection,one of EMR method,should be popularized widely in clinical practice.5.For colorectal polyps with long thick peduncle,submucosal injection-resection and high-frequency electrocoagulation resection combined with nylon trap surgery or mental titanic clips are effective,but the latter is safer. |
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