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背景:结肠镜检查发现的结直肠息肉以直径≤5 mm的微小息肉(DP)最为常见。目前关于DP内镜下处理方式的报道尚少。目的:分析结直肠DP的内镜、病理特点和处理方式,为其临床诊治提供参考。方法:收集2010年1月~2011年4月青岛市市立医院结肠镜检查病例的临床资料,纳入其中发现结直肠息肉并符合DP标准者,凡合并较大息肉(≥6 mm)者予以排除。回顾性分析DP的内镜特点、病理性质和处理方式。结果:共纳入结直肠DP病例269例(402枚DP),占同期息肉检出例数的21.8%,其中180例(66.9%)为单发。43.3%的DP分布于直肠、乙状结肠,60.0%的DP直径>3 mm,绝大多数DP形态为山田Ⅰ型(53.5%)或山田Ⅱ型(42.0%)。305枚送病理检查的DP中,绝大多数为腺瘤性息肉(50.2%)或炎性息肉(47.5%);>3 mm的DP为腺瘤性的可能性较大,≤3 mm者多为非肿瘤性(P<0.05)。66.9%的DP系以活检钳钳除;>3 mm、山田Ⅱ+Ⅲ型和多发DP采用热活检钳钳除或高频电凝切除的可能性较≤3 mm、山田Ⅰ型和单发DP更大(P<0.05)。结论:对于直径>3 mm的结直肠DP,行内镜下高频电凝切除可能更为有效,并应送病理检查,以免漏诊进展期腺瘤。
Background: Colorectal polyps, found by colonoscopy, are most common with tiny polyps (DP) of ≤5 mm in diameter. At present, there are few reports on the treatment of DP endoscopy. Objective: To analyze the endoscopic, pathological features and treatment of colorectal (DP), and provide reference for its clinical diagnosis and treatment. Methods: The clinical data of colonoscopy in Qingdao Municipal Hospital from January 2010 to April 2011 were collected and included in those who found colorectal polyps and met the DP criteria. Any patients with large polyps (≥6 mm) should be excluded. Retrospective analysis of DP endoscopic features, pathological properties and treatment. Results: A total of 269 cases (402 DP) of colorectal DP were enrolled, accounting for 21.8% of the cases with polyp detected in the same period. Among them, 180 cases (66.9%) were single. 43.3% of the DP was distributed in the rectum and sigmoid colon, 60.0% of the DP was> 3 mm in diameter, and most of the DPs were Yamada type I (53.5%) or Yamada type II (42.0%). 305 sent to the pathological examination of DP, the vast majority of adenomatous polyps (50.2%) or inflammatory polyps (47.5%);> 3 mm of the DP is more likely to adenoma, ≤ 3 mm were more Non-neoplastic (P <0.05). 66.9% of the DP Department of biopsy forceps removed;> 3 mm, Yamada Ⅱ + Ⅲ type and multiple DP with thermal biopsy forceps or high frequency coagulation than the possibility of less than 3 mm, Yamada type Ⅰ and single DP Larger (P <0.05). Conclusion: For colorectal DP> 3 mm in diameter, endoscopic high frequency electrocoagulation may be more effective and should be sent for pathological examination to avoid missed diagnosis of advanced adenoma.