Clinical Analysis Of Diagnosis And Treatment Of Colonic Polyps In Children

Objective: Colonic polyps is one of the common cause of lower gastrointestinal tract bleeding in children, of which it’s pathogenesis is still unclear. The pathology of colonic polyp is diverse, and has a certain probability of malignancy, therefore early diagnosis and appropriate treatment is very crucial to improve the prognosis. This study data collected by diagnosis under colonoscopy and hanving polypectomy,analysis the influence factors of pathogenesis in child with colonic polyps, features of clinical manifestation, microscopic morphology and histopathology,in order to further optimize the diagnosis,evaluation and treatment of colonic polyps in children,improving the cure rate and prognosis.Materials and methods: 193 cases of colonic polyps were collected in the children hospital of Soochow University during the period of July 2010 to July 2015.The cases must meet the following criteria:(1)less than 14 years old;(2)diagnosed under endoscopy;(3)colonic polyps had been cut by endoscopic resection. All statistics were calculated with software SPSS19.0.Quantitative data were presented as means±SD,Normal distribution data comparison between the groups use two-sample t-test, non-normal distribution data and heterogeneity of variance data use Wilcoxon signed-rank test.Count data and rate comparison, using the chi-square test and Fisher’s exact probability.Differences between groups means with P values <0.05 were regarded as being statistically significant.Results: 1. 193 cases were included in our study.131 boys and 62 girls, the ratio of boy to girl was 2.11:1, with the average of 4.61±2.16 years. There were 86 cases aged between 3 to 5 years old.2.According to the length of the course,all cases were divided into two groups: short term group(6 months or less), long term group(> 6 months), The shortest duration was by one week, while the longest duration was by 4 years, with average of 7.29±8.30 months. There was no significant difference observed between the two groups in the rate of underweight and anemia, the level of hemoglobin, serum albumin and pre-albumin(P > 0.05);3. The feature of clinical manifestation were diverse,191 cases of hematochezia(98.7%). 26 cases(13.47%) of protruding tumor,13 cases(6.74%) of Atopic constitution(including eczema, food allergies, asthma), 25 cases(12.95%) of increased eosinophil count(> 4%),15 cases(7.77%) of intestinal infection,and 12 cases(6.22%) combined functional constipation(Roman Ⅲ functional constipation diagnosis standard).4. The colonoscopy found 197 polyps, in which 189 were single polyp(95.94%), and8 multiple polyps(4.06%).9polyps(4.57%) distributed in the right colon.188 polyps(95.43%) in the left colonic polyps, and 166polyps(84.26%)were located in the rectum and sigmoid colon.According to diameter, all of the polyps were divided into 3 groups: huge polyps group(> 1.5 cm), large polyps group(0.5~1.5 cm), and small polyps group(<0.5 cm). There were 17 cases of small polyps(8.63%), large polyps account for 119 cases(60.40%), and 61 cases for huge polyps(30.96%). Between the three groups, there was no significant difference in age, gender, and duration of the disease(P>0.05);5. There were 153 polyps were checked by histopathologic examination,showing that 151cases(98.69%) of juvenile polyps, inflammatory polyp count for 2 cases(1.31%), there were no finding of adenomatous polyps and malignant polyps. The correlation between polyp size and histopathological types cannot be evaluated;6. According to whether or not to use the titanium clips, the study group were divided into 2 groups,54 cases with titanium clip, in which only 1 case with re-curring hematochezia within 3 days after colonoscopy. 139 cases that were treated without using the titanium clip,in which 16 cases with hematochezia, and 3 cases need retreatment under colonoscopy. There was signifficant difference in the safety between the two groups(P < 0.05).Conclusions:1.Hematochezia(bloody stool),abdominal pain and anal tumor are the main complains of colonic polyps in children;2.The colonic polyps only have few effects on nutritional status, growth and development in children;3. Constipation and atopic constitution may be important factors in the development of colonic polyps;4. The size of colonic polyps has no close relationship with the age,gender and duration of the disease;5. The high frequency electrocoagulation resection with titanium clip is one of safe and effective treatment methods for polypectomy in children.