标题：结肠镜联合腹腔镜治疗结直肠息肉疗效观察

      作者：林建园 1，群英英 2，钟远慎 2，董功航 1，高朝腾 1，余宗洋 1    （1.广州医科大学附属深圳沙井医院消化内科，广东 深圳 518104；2.深圳市光明新区中心医院内分泌科，广东 深圳 518107）

      卷次： 2017年28卷1期

      【摘要】 目的 探讨结肠镜联合腹腔镜治疗结直肠息肉的安全性和临床疗效，为临床医生有效治疗结直肠息肉提供理论依据。方法 选取2012年1月至2014年2月期间于广州医科大学附属深圳沙井医院就诊且活检病理结果为良性，行结肠镜无法独立切除的结直肠息肉患者80例，按随机数表法将患者分为观察组和对照组，每组40例，观察组患者行结肠镜联合腹腔镜切除术，对照组行开腹切除术。比较两组患者的手术时间、住院时间、术中出血、肠功能恢复时间等指标。同时探究息肉直径、数量与癌变的关系。结果 观察组患者的手术时间、术中出血量和肠蠕动恢复时间分别为(84.7±17.2) min、(33.7±9.8) mL和(6.7±2.4) d，明显少于对照组的(107.2±22.7) min、(117.5±21.6) mL和(8.5±4.9) d，差异均具有统计学意义(P<0.05)；术中出血量方面，观察组出血量明显低于对照组，差异有统计学意义(P<0.05)。经术后病理切片验证，息肉直径≥2 cm者癌变率高达47.6%，息肉直径<2 cm者癌变率仅为6.8%，两者比较差异有统计学意义(P<0.05)；单发息肉癌变率为5.2%，多发息肉癌变率则高达38.1%，两者比较差异有统计学意义(P<0.05)；两组患者均未出现严重并发症。结论 结肠镜联合腹腔镜治疗结直肠息肉可显著缩短患者手术时间、住院时间及肠功能恢复时间。
      【关键词】 结肠镜；腹腔镜；结直肠息肉；联合治疗；疗效
      【中图分类号】 R574.62 【文献标识码】 A 【文章编号】 1003—6350（2017）01—0060—03

Curative effect of colonoscopy combined with laparoscopy in the treatment of colorectal polyps.
LIN Jian-yuan 1,QUN Ying-ying 2, ZHONG Yuan-shen 2, DONG Gong-hang 1, GAO Chao-teng 1, YU Zong-yang 1. 1. Department ofGastroenterology, Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen 518104, Guangdong,CHINA; 2. Department of Endocrinology, Shenzhen Guangming New District Central Hospital, Shenzhen 518107,Guangdong, CHINA
【Abstract】 Objective To explore the safety and clinical efficacy of colonoscopy combined with laparo-scope in the treatment of colorectal polyps, and to provide theoretical basis for the effective treatment of colorectalpolyps. Methods A total of 80 patients with colorectal polyps (confirmed as benign by biopsy), who underwent lapa-roscopic colectomy in Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University from January 2012 toFebruary 2014, were selected. Patients were randomly divided into observation group and control group, with 40 pa-tients in each group. The observation group underwent colonoscopy combined with laparoscopic resection, and the con-trol group underwent open cholecystectomy. The operation time, length of stay, bleeding during operation, and recov-ery time of bowel function between the two groups were compared. At the same time, the relationship between the di-ameter of the polyp, the quantity and the malignant transformation were explored. Results The operation time, bleed-ing during operation and recovery time of intestinal peristalsis in observation group were respectively (84.7±17.2) min,(33.7±9.8) mL and (6.7±2.4), which were significantly less than those in control group of (107.2±22.7) min, (117.5±21.6) mL and (8.5±4.9), and the differences were statistically significant (P<0.05). The bleeding during operation inobservation group was significantly lower than that in control group, and the difference was statistically significant(P<0.05). Pathological analysis showed that malignant transformation rate of colorectal polyps with diameter ≥2 cmreached to 47%, but that of the ones with diameter <2 cm was 7.1% only. There were statistically significant differ-ences between the two groups (P<0.05). The malignant transformation rate of single polyp was 4.3%, and the malig-nant transformation rate of multiple polyps was 38.1% , with statistically significant differences between the twogroups (P<0.05). There were no serious complications in both groups. Conclusion Colonoscopy combined withlaparoscopy in treatment of colorectal polyps can significantly shorten the operation time, length of stay, and bowelfunction recovery time.
      【Key words】 Colonoscopy; Laparoscopy; Colorectal polyps; Combined therapy; Curative effect·论 著·doi:10.3969/j.issn.1003-6350.2017.01.018基金项目：广东省深圳市宝安区科技计划社会公益项目（编号：2015198）