colonoscopic colorectal polypectomy

High-frequency electricity or microwave, or laser removal or coagulation of large and small intestine polyps by colonoscopy or sigmoidoscopy is a major improvement in the treatment of polyps. The patient avoids the pain of laparotomy and can remove multiple polyps at a time. For example, the patient is young, the polyp is pedicled, and there is no arteriosclerosis. One time, 10 cm of polyps of 1.0 cm size can be removed. For example, if the small polyps are condensed, it can be around 30 pieces. However, for elderly patients with arteriosclerosis, the number of snares should not be more than 5, and the number of clotting should not exceed 20. If the malignant transformation of the polyp is removed by colonoscopy, the cancer can only be infiltrated into the mucosa without undergoing radical surgery. If the cancer infiltrates into the submucosa, but the polyps have pedicles, the stumps are cancer-free, the tumors are well differentiated, and the lymphatic vessels and blood vessels are not infiltrated by cancer. They can be closely observed after colonoscopy. Treatment of diseases: colorectal polyps Indication Colonoscopy for large intestine polypectomy for: 1. A small polyp without pedicles. 2. There is a polyp, but its pedicle is <2.0cm. 3. The polyp is broadly baseted, but the polyp itself is <2.0 cm. Contraindications 1. Those with severe hypertension and coronary heart disease. 2. Patients with severe abdominal pain, bloating, nausea, vomiting and other symptoms of intestinal obstruction. 3. Patients with diffuse or localized peritonitis, or suspected intestinal perforation. 4. Those with bleeding disorders. 5. Polyp base > 2.0 cm. 6. The polyposis of the polyp has infiltrated into the pedicle. 7. Polyp clusters exist in a wide range. 8. Patients during pregnancy. 9. Less weak, or unable to cooperate. Preoperative preparation 1. Detection, clotting time, platelets. 2. Simulation test: Check whether the high-frequency electricity generator works normally, and adjust the current intensity according to the size of the polyp. 3. 2d semi-liquid diet before the removal of polyps, 1d liquid diet, line the polyps to remove the breakfast on the day, such as the hungry can enter a small amount of sugar. 4. There are two main methods for intestinal cleansing: 1 Oral castor oil method: 30 ml of oral castor oil is taken before the night, diarrhea occurs after 3 to 4 hours, and cleaned with warm water (about 37 °C) 1 to 2 hours before the test. Enema. Generally do not use soapy water to enema, so as not to stimulate the intestinal mucosa to cause congestion and edema. 2 oral magnesium sulfate method: 25% before the examination, 25% of magnesium sulfate 150 ~ 200ml, and then served 5% grape brine (or warm water) 1000ml, served within 2h. The diarrhea started 45 minutes after the service. After 5 or 6 times of diarrhea, the intestinal tract is more clean and can be checked. Before the removal of polyps, mannitol is prohibited from preparing for intestinal tract to prevent the generation of flammable gas methane. When the electric polyp is burned, an electric spark is generated and an intestinal explosion occurs. 5. Use a pacemaker with caution. Surgical procedure 1. The method of removing the polyp (1) Remove the fecal water and mucus around the polyps to prevent electrical damage to the intestinal wall. (2) Change the position if necessary to fully reveal the polyps. Expose the polyps to the 3, 6, and 9 o'clock positions for trapping. (3) Replace the air in the intestinal cavity 2 or 3 times to prevent the concentration of flammable gas in the intestines from being high and causing an explosion. (4) The looped silk should be placed on the neck of the polyp. The small polyps should be suspended. The large polyps should make the polyp head widely contact the contralateral intestinal wall. Do not touch too little, and the current density is high to burn the intestinal wall. (5)>3.0cm is not a lobulated giant polyp, each time the trap can not be >2.0cm, in case the cutting part is in contact with each other when cutting to a certain extent, the current density dispersion can not produce high temperature excision polyps, so that the snare wire is trapped Within the polyp organization, advance and retreat cannot. (6)> 3.0cm large lobulated polyps should be burned from the polyps around the lobe to the polyp pedicle, so that the larger blood vessels in the polyp pedicle are repeatedly affected by heat and current and clotting, do not blindly fit into the pedicle Complications occurred due to unclear vision or incomplete lysis of the pedicle. (7) The general high frequency electric generator uses a mixed current of 2.5 to 3.5 steps. (8) Turn on the power, energize, power on for 2 to 4 s each time, and energize one or more times as appropriate. (9) When the power is turned into a white or white smoke at the ferrule, the assistant gradually tightens the snare, and tightens the ferrule while intermittently energizing. The surgeon and assistant must work properly to prevent bleeding due to insufficient energization or tightening of the snare, resulting in bleeding due to incomplete clotting, or breakdown of the intestinal wall due to excessive power. 2. Remove the polyps with a hot biopsy forceps Mostly used for polyps of 0.5cm size. (1) Use a solidification current of 2.5 to 3 stops. (2) Clamp the polyp head to lift, so that the base of the polyp forms a slender pseudo pedicle. When the power is applied, the current density of the pseudo pedicle is increased to produce a high temperature exfoliation polyp. The polyps in the clamp ring are less affected by the current and are feasible for histological examination. 3. Using a coagulator to coagulate the polyp method (1) The solidification current for the high-frequency electric generator is 2 to 3 steps. (2) The coagulator is aimed at the polyp head, and 2/3 of the polyps can be condensed to achieve the therapeutic purpose, but it is not suitable to condense too deep to prevent perforation. complication Enteral perforation Surgical treatment should be performed as soon as it occurs. 2. Polyp residual bleeding Including intraoperative bleeding and hemorrhage caused by escharectomy about 1 week after surgery, such as bleeding can be stopped by endoscopic high-frequency electrocoagulation. Method: The coagulation current of the high-frequency electric instrument is 2 or 3 steps, and the electrocoagulator is energized for 2 to 3 seconds at the contact point of the hemorrhage, and is energized once or several times. When the coagulator is lifted, it is energized 1 or 2 times to break the eschar and prevent the eschar from being pulled back. 3. Retroperitoneal balloon swelling Apply antibiotics, gradually absorb them, and pay attention to cardiopulmonary function.