老年大肠息肉患者临床特点、内镜下处理及安全性分析

目的探讨老年大肠息肉患者临床特点、内镜下处理策略及相关并发症。方法回顾性整理老年大肠息肉患者407例941枚的临床资料,分析息肉的大小、部位、形态、病理学特点、内镜治疗及并发症情况,并与同期中青年人大肠息肉225例305枚进行对比分析。结果大肠息肉检出率在老年及中青年组分别为27.8%及6.3%(P<0.05);直肠、乙状结肠是息肉的好发部位,但老年人右半结肠息肉明显增多,横结肠、升结肠检出率分别为11.2%、10.8%,而中青年人分别为6.6%、6.9%(P<0.05);老年人中多发性息肉占72.7%,明显高于中青年人的43.9%(P<0.05);老年组息肉最大直径≥2 cm的息肉及分叶状息肉比例相对增多分别为(6.6%vs 3.6%及8.4%vs 4.9%,P<0.05);病理结果显示老年人与中青年人腺瘤性息肉所占比例分别为63.0%及46.2%(P<0.01);老年人及中青年组息肉伴癌变率分别为4.4%及2.0%(P<0.05)。老年组941枚息肉中,活检钳除662枚,高频电切223枚,因癌变或息肉较大需外科手术治疗56枚;内镜下均成功切除息肉,无治疗相关肠穿孔及死亡病例。老年组内镜治疗后,有7例并发出血,均为套圈电切术后出血,活检钳除者未见出血并发症。其中,早发性出血(EPPB)2例,迟发性出血(DPPB)5例,均内科及急诊肠镜处理后止血。结论老年人大肠息肉处理应根据大小、部位、形态、病理采用不同的策略,内镜下摘除老年人大肠息肉安全、有效、可行。

Clinical feature, endoscopic therapy and safety analysis of colorectal polyps in the elderly patients

Objective To explore the clinical feature,the endoscopic treatment of colorectal polyps in the elderly.Methods The clinical data of 407 aged patients with colorectal polyps were analyzed,including polyps size,location,shape,histopathologic characters and endoscopic therapy outcome.Results The detective rate of colorectal polyps in the aged people were 27.8%,which was higher than that of the young and the middle-aged people(6.3%,P<0.05).Colorectal polyps lie in right colon was more frequent in the elderly than that of the younger people.The detective rate of transverse and ascending colon in the elderly group were 11.2% and 10.8% respectively,which were significantly higher than those of the younger group(6.6 % and 6.9%).The cases of multiple polyps in the elderly was 72.7%,which was higher than that of the younger group 43.9%(P<0.05).The colonic polyps in the aged group was predominantly adenomatous polyps(63.0%),being significantly higher than that in the young group(46.2%,P<0.01).The ratio of adenomatous polyps,in diameter ≥2 cm and cauliflower-like polyps were higher than those of the youngerly′s relatively.The ratio of polyps with malignant change were 4.4% and 2.2% in the elderly group and the younger group respectively(P<0.05).Of all 941 polyps in the elderly group,662 polyps removed with biopsy forcep,223 polyps removed with snare and 56 polyps treated with surgery.There were no endoscopic procedure-related intestinal perforation and death.The ratio of post-polypectomy bleeding(PPB)was 3.1%(7 cases),in which 2 cases had early post-polypectomy bleeding(EPPB) and 5 cases had delayed post-polypectomy bleeding(DPPB).All of PPB were stopped by medicine or urgent colonoscopic therapy.Conclusions The treatment strategy of colorectal polyps depends on the polyp size,location,shape,and histopathologic characters.The colonoscopic therapy to remove the colorectal polyps in aged people is safe,effective and feasible.