氩离子凝固术治疗不同病理类型结直肠息肉的疗效观察

目的：氩离子凝固术（Argon-plasma coagulation，APC）可以有效地治疗结直肠息肉，对不同病理类型息肉的疗效是否存在差异，目前尚不清楚。本文比较APC治疗不同病理类型结直肠息肉的效果。方法：对62例结直肠息肉患者共112枚结肠息肉行APC治疗，其中17例亚蒂和74例扁平息肉仅用APC治疗；21例有蒂息肉电切治疗后用APC处理息肉残基，治疗结束后1个月进行结肠镜随访。结果：112枚结直肠息肉经一次APC治疗均成功清除，随访期间共有4例（6．5％）患者出现复发，均为直肠腺瘤性息肉，经再次APC治疗后彻底清除。单纯APC治疗组复发3枚（3．3％）；电切后用APC处理残端组术后复发1枚（4．7％），两组间复发率无显著差别（P〉0．05），腺瘤性息肉的复发率显著高于其他两种病理类型（P〈0．05）。1例直肠有蒂息肉经圈套器切除后APC处理残端时出现黏膜下气肿，3例患者出现了短暂的腹痛，未经处理缓解，其余患者无特殊并发症。结论：APC是一种安全有效的结直肠息肉治疗方法，但对腺瘤性息肉APC治疗后应加强随访，以确保治疗成功。

Efficacy of Argon Plasma Coagulation in Management of Different Pathologic Types Colorectal Polyps

Objectives： To assess the outcome and safety of Argon-plasma coagulation （APC） in the management of the different pathologic types colorectal polyp. Methods：62 patients with 112 colorectal polyps were treated with APC ablation. 74 sessile and 17 semi-pedunculated polyps were only treated with APC, whereas 21 pedunculated polyps were treated with piecemeal polypectomy and polyp remnants were also treated with APC. Follow-up endoscopies had been performed 1 month after the treatment completion. Results ：Complete ablation was achieved in all poplys in the course of one session. After a follow-up period of 1 month, recurrence was observed in 4 （6.5 % ）of all patients, each of them with an adenomas polyp in the rectum. All recurrences were managed by APC again satisfactorily. There was no relationship between recurrence and previous piecemeal polypectomy. Three poplys out of 91 （3.3%） that had been treated exclusive- ly with APC recurred, and so did one poply out of 21（4.7%） that had been treated with both methods （P〉0. 05）. Adenomas poplys had a significantly higher recurrence rate than poplys with other pathologic types （P〈0.05）. Intestinal wall emphysema had been encountered in one patient when APC had been used to ablate a rectum poply remnant after piecemeal polypectomy. Transient mild abdominal pain had been encountered in three patients and relieved without treat ment. No other than complications had been encountered. Conclusions ：APC is an effective and safe method in the management of colorectal polyp, but adenomas poplys have a possibility of recurrence, therefore endoscopic follow-up is needed to confirm the complete ablation.