老年大肠广基息肉内镜黏膜切除术的临床研究

Clinical value of endoscopic mucosal resection for elderly patients

目的探讨内镜黏膜切除术(EMR)对老年广基息肉病变的治疗价值及安全性。方法采用结肠镜下大肠黏膜切除术治疗117例共157枚大肠广基息肉。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,回收标本送病理检查,术后结肠镜随访。结果全部息肉通过EMR一次切除,切除息肉大小在1～5cm范围;腺瘤性息肉141枚,增生性息肉13枚;局灶癌变3例(病理证实)。4例出现腹痛,3例少量便血,发烧4例,不需要特殊处理。复查患者未有息肉残留者。腺瘤息肉异型增生程度与息肉大小密切相关(P<0.05)。结论老年大肠广基息肉通过EMR切除完全,安全;腺瘤息肉的大小与异型增生密切相关,提示腺瘤息肉需要早期干预治疗。

Objective To investigate the value and safety of endoscopic mucosal resection （EMR） in elderly patients with large sessile colorectal polyps. Methods 117 elderly patients with large sessile colorectal polyps were included. Polyps removed received pathological examination. All patients were followed up by endoscope after EMR for six months or one year. Results 157 polyps were removed by EMR, and 141 were adenomatous polyps, 13 hyperplastic polyps and 3 submueosal cancers, respectively. Among 117 cases, 4 cases presented with abdomen ache, 3 with very small volume of intestinal bleeding and 4 with fever, respectively. They recovered after conservative therapy. The grade of dysplasia of colorectal adenomatous polyps was related to the size of polyp（ P 〈 0. 05 ）. Conclusions Elderly patients with colorectal polyps using EMR methods are useful and safety. The colorectal adenomatous polyps should be removed early.