巨大结肠息肉的外科治疗策略探讨(附39例报告)

Surgical therapy strategy of giant colonic polyps (a 39 cases report)

目的：探讨巨大结肠息肉合理的外科治疗策略,对治疗方法进行评价。方法：将127枚直径≥1cm的结肠息肉按大小分3组。其中巨大结肠息肉（直径≥3cm）39例,对其病理特征、治疗方法进行分析,并回顾文献。结果：直径1~2cm的息肉共47枚,其中16枚高级别上皮内瘤变,腔镜手术1例,其余肠镜下切除;直径2~3cm的息肉41枚,其中高级别上皮内瘤变23枚,3枚开腹手术,12枚双镜联合手术,其余肠镜下切除;直径≥3cm的息肉39枚,其中高级别上皮内瘤变28枚,9枚开腹手术,10枚双镜手术,其余肠镜下切除。本组巨大结肠息肉高级别上皮内瘤变的诊断率、肠镜下切除不良事件发生率与前2组相比,均存在显著性差异（均P〈0.05）。结论：对于不能在初次肠镜下切除的直径≥3cm的巨大结肠息肉,腹腔镜联合肠镜手术切除是较为妥善的选择。

Objective：To investigate the reasonable surgical therapy strategy of giant colonic polyps.Methods： We divided 127 cases of coloreetal polyps with the diameter l-2cm into three groups according to the size. We assessed the surgical therapy strategy of giant colonic polyps,by analyzing the pathological findings and the therapy strategies.We also reviewed the current insights reported in the literatures.Results：In the study in- cluded 47 cases of colonic polyps with diameter 1-2cm,in which there were 16 cases of high-grade intraep- ithelial neoplasia.One ease was treated by laparoseope,and the others were treated by eolonoscope.There were 41 eases of colonic polyps with diameter 2-3era,in which there were 23 cases of high-grade intraepithelial neoplasia.Three eases were treated by laparotomy,and 10 ease by laparoseope combined with eolonoseope,and the others by eolonoseope.There were 39 eases of colonic polyps with diameter≥3cm,in which there were 30 eases of high-grade intraepithelial neoplasia.Eight eases were treated by laparotomy, 12 eases by laparoseope, and the others by eolonoscope.In the eases of colonic polyps with diameter≥3cm,the diagnostic yield of high- grade intraepithelial neoplasia and the incidence of adverse events by the eolonoseope significantly differed from which in the other 2 groups （P〈0.05）.Conclusion：For the gianteolonie polyps with diameter≥3cm,whieh cannot be reseeted by eolonoseopy at the first time,the surgical therapy strategy of laparoseopy combined with eolonoseopy is the reasonable choice.