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目的:探讨成人结肠镜在小儿出血性结直肠息肉诊治中的应用价值。方法:对便血患儿进行成人肠镜检查并电切除治疗息肉,分析息肉的临床表现、镜下形态、病理特点,评估其安全性。结果:85%便血患儿发现结直肠息肉,临床症状主要为便血(35/35),腹痛(5/35),肛门有肿物脱出(9/35),粪便表面可见沟槽(6/35),直肠指检可触及肿块(8/35)。35例患儿发现息肉共38颗,单发占91.4%(32/35),多发3例,大小多数在2cm左右。息肉主要在直肠占73.7%(28/38),在直肠和乙状结肠共占92.1%(35/38)。息肉均在肠镜下成功微创电切治疗,术中、术后无肠出血、肠穿孔并发症,电切成功率为100%。息肉病理检查,多数为幼年性息肉占73.7%(28/38),少数为增生性息肉占15.8%(6/38)和炎性息肉占10.5%(4/38)。术后未再便血。结论:结直肠息肉是小儿便血的最常见原因,息肉主要在直肠和乙状结肠,多为单发,病理以幼年性息肉为主,电切息肉后未再便血。成人结肠镜对小儿出血性结直肠息肉的检查和微创电切治疗是安全有效的。
Objective: To investigate the value of adult colonoscopy in the diagnosis and treatment of hemorrhagic colorectal polyps in children. Methods: Adult patients with blood in the stool were enrolled in the colonoscopy and electrosurgical treatment of polyps. The clinical manifestations, microscopic morphology and pathological features of polyps were analyzed to evaluate their safety. Results: Colorectal polyps were found in 85% of patients with blood in the stool. The main clinical symptoms were blood in the stool (35/35), abdominal pain (5/35), prolapse of the anus (9/35) ), Rectal examination palpable mass (8/35). 35 cases of polyps found in a total of 38 children, 91.4% of single hair (32/35), multiple in 3 cases, most of the size of about 2cm. Polyps mainly accounted for 73.7% (28/38) in the rectum and 92.1% (35/38) in the rectum and sigmoid colon. Polyps were successfully treated with minimally invasive electrosurgical excision under colonoscopy. No postoperative bleeding, intestinal perforation complications were found. The success rate of electrosurgical excision was 100%. The majority of pathological findings of polyp were 73.7% (28/38) in juvenile polyps, 15.8% (6/38) in minority polyps, and 10.5% (4/38) in inflammatory polyps. No postoperative blood in the stool. Conclusion: Colorectal polyps is the most common cause of pediatric blood in the stool. Polyps are mostly in the rectum and sigmoid colon. Most of them are solitary polyps. The pathology is mainly juvenile polyp. Adult colonoscopy on hemorrhagic colorectal polyps in children and minimally invasive electrosurgical treatment is safe and effective.