Curative Effect Analysis Of Resection Of Large Colonic Polyps Under Endoscopic And Surgical

Background and objectiveColonic polyp is a common digestive disease and could occur in any part of the colon.It is the proliferation of the colonic mucosal epithelium and can be divided into the tumorous polyps and the non-tumorous on histology.The Tumorous polyps consist of tubular adenoma, villous adenoma and tubular villous adenoma,and the other consist of hyperplastic polyps, inflammatory polyps and hamartoma.The polyps were defined large polyps if their Diameter are greater than2cm in a lot of information.With the rapid development of economy, the incidence of colon polyps also has increased rapidly in recent years, and closely associated with colorectal cancer.And the canceration rate of colonic polyps associates With the tissue typing, and the size of the tumors, epithelial hyperplasia and so on.Studies suggest that the canceration rate of tubular adenoma was Less than5%, tubular papillary adenoma was23%, and papillary adenoma wan from30%to70%.The canceration rate of Adenoma whose diameter is0.5cm is less than or equal to0.1%,<1cm is1%-3%,1-2cm is10%, and larger than2cm is as high as30%-50%.And the canceration rate of Adenoma in mild epithelial atypical hyperplasia is low, in severe can amount to27%.According to the statistics, the canceration time need about7-10years. Therefore, it is great important to detect and treat colon polyps early.In the past, surgical resection is aways as the preferred treatment of colon polyps.But the traditional surgical laparotomy often need a large incision, and result in patients who suffer big trauma and a lot of pain and recover slowly.It was reported that using endoscopy mechanically remove gastrointestinal polyps in Changgang since1968,and Shinye first reported that colonic polyps were excised by endoscopic electrocoagulation,a variety of new endoscopic treatment technology develop rapidly and has gradually replaced some surgery.Especially the development of endoscopic high-frequency electrocoagulation, nylon trap surgery,endoscopic mucosal resection (EMR) and endoscopic submucosal dissection(ESD) and so on, and combined with the technology of painless anesthesia,which made the diameter of colonic polyps larger than2cm is no longer the contraindication of endoscopic treatment.Currently endoscopic treatment has become the preferred treatment of colon polyps,except that colon polyp which was definitely precancerous must surgery.The endoscopic treatment not only makes many patients avoid the pain of surgery, but also greatly reduces the incidence of colorectal cancer as a premalignant lesion-adenomatous polyp was early removed,which also could treat the local primary carcinoma which limited to the top of the polyp.This paper mainly discusses the curative effect of the colon polyp (>2cm) by endoscopic treatment as a whole is whether or not superior to surgery,including hospitalization time,surgical expenditure, postoperative complications, postoperative fasting time, postoperative recovery and so on.MethodsWe retrospectively analyzed our hospital patients who were detected the large colonic polyps(>2cm) by electronic colonoscopy and drawn biopsy in the preoperative,exclude malignant lesions in88cases of postoperative patients from January2010to August2011. And Select the48cases of large colonic polyps patients who were resected by endoscopic for endoscopic treatment group, surgical resection of40cases as control group.After the large colonic polyps were resected,We investigated retrospectively the two groups of the polyp size, position, quantity, pathological histology, length of hospital stay, treatment costs, the postoperative complications and postoperative fasting time,postoperative recovery time respectively, and using rank test and continuity correction of x squared inspection of SPSS17.0statistical software for data processing, with P<0.05for the difference was statistically significant.Results1The incidence rate of postoperative complications (such as hemorrhage, perforation, infections, etc.) of endoscopic treatment group is6.25%, and the surgical group is25%, there are statistically significant differences (P<0.05). 2The postoperative fasting time of Endoscopic treatment group compared with the surgical is short,and there are statistically significant differences (P<0.01).3The endoscopic treatment group in hospital time is shorter and expend less than the surgical, there are statistically significant differences(P<0.05).43months after the operation, the colonic polyp patients were reviewed colonoscopy,we found the endoscopic treatment group patients generally Only found scarring in the focal pathological changes,, even a few had returned to normal; While surgical treatment group often found hyperemia, edema, and even more erosion, ulcer.Half a year after the operation,we found endoscopic treatment group only be watched normal colon mucosa in the focal pathological changes, but the other group was scarring.Conclusions1Because of endoscopic treatment removed colon polyps through the body’s natural channel with endoscopic instruments, don’t need to open enterocoelia,and the patients only need suffer small trauma and a little pain;While traditional surgery is to excise pathological bowel loops directly by laparotomy, and need big trauma, so the patients’postoperative recovery would slow, even prone to complications such as infection, bleeding and so on.2Comparison of the two groups about postoperative fasting time:the control group is significantly higher than treatment group, it reflects that the endoscopic therapy group has the characteristics of small trauma, early postoperative exhaust and defecation,and fast recovery of the intestinal function.3Through the comparison of length of hospital stay and cost of treatment, the treatment group was significantly lower than the control group, and two groups have significant statistical significance (P<0.01), it reflected that the endoscopic treatment not only has the characteristics of fast postoperative recovery, but also greatly reduce the economic burden of the patients.4Postoperative follow-up results showed that the treatment group compared with control group has the characteristics of postoperative wound healing fast and small scars.5The malignant colonic polyps were treated by endoscopic therapy is superior to surgery; Many Precancerous lesions and early cancer can be treated by advanced endoscopic technology, to improve the patients’survival rate and avoid surgery, that also can save a lot of resources.