内镜黏膜切除术治疗大肠广基大息肉

Large sessile colorectal polyps underwent endoscopic mucosal resection

目的探讨内镜黏膜切除术(EMR)对肠道广基大息肉样病变的治疗价值。方法采用结肠镜下大肠黏膜切除术治疗135例共157个结直肠广基大息肉。病灶黏膜下注射肾上腺素生理盐水后,一次圈套整块切除或分次圈套切除病变,回收全部标本送病理检查,术后结肠镜随访。结果全部息肉EMR一次切除,除3个位于直肠黏膜下的病灶小于1 cm外,其余均大于1.5 cm,最大的13 cm×12 cm,无手术并发症。术后病理:腺瘤123个,其中有异型增生80个;黏膜内癌11个;增生性息肉20个;直肠类癌3个。随访中,有2例大于7 cm的直肠腺瘤分别于术后1个月及3个月复查时复发,均给予热活检钳完整钳除,病理分别为增生性息肉和绒毛状腺瘤,再复查6-12个月无复发。结论EMR是治疗大肠癌前病变及黏膜内癌安全、有效的方法。

Objective To evaluate the outcome of endoscopic mucosal resection （EMR） of large sessile colorectal polyps. Methods One hundred and thirty five patients with 157 large （〉 1.5 cm） sessile colorectal polyps referred for EMR. After submucosal injection of epinephrine, either en bloc or piecemeal snare polypectomy were performed. All resected specimens were retrieved for pathologic study. Follow-up colonoscopy was performed in all patients after EMR. Results All 157 polyps were removed completely. All lesions are larger than 1.5cm, but 3 less than 1 cm on the submucosa of rectum. The largest one is 13 cm×12 cm. No complication occurred. Histopathologic assessment of the resection specimens revealed the following： adenoma, 123; dysplasia, 80; mucosal carcinoma, 11; hyperplastic polyps, 20; rectal carcinoid, 3. Two patients who had rectal adenoma that was larger than 7era recurrence happened at the resection site after 1 and 3 months follow-up respectively, than removed completely by hot biopsy forceps showed hyperplastic and villous adenoma on pathological study. No more residual tumor was detected for 6-12 months. Conclusion EMR with an intensive follow-up program is a safe and effective treatment for large sessile colorectal polyps and mucosal carcinoma.