平坦型结直肠腺瘤黏膜切除术的疗效和安全性评价

Evaluation of the efficacy and safety of fiat colorectal adenoma mucosal resection

目的评价内镜下黏膜切除术（EMR）治疗结直肠腺瘤（CRA）的疗效和安全性。方法回顾性分析2009年2月至2012年12月35例CRA行EMR治疗患者的资料，选择直径≥10mm的平坦型腺瘤为研究对象，分析其临床表现、病变部位、大小、治疗经过及内镜和病理特征，统计病灶残留率、并发症发生率以及局部复发率。结果患者平均年龄（61±12）岁，35例患者中发现38个病灶，病变平均（18±8）mm，病变多数位于盲肠／升结肠（44．7％，17／38）。整块切除术占60．5％，病变直径〉20mm的病灶具有较高的分片切除率（／9〈0．01）和切除后病灶残留率（P〈0．05）。内镜下完整切除率达到92．1％。组织学分类中低级别上皮内瘤变占多数（78．9％），并发症发生率为5．7％，平均随访时间（16±9）个月，局部复发率为17．2％（5／29）。结论EMR治疗平坦型CRA是有效和安全的。病变〉20I／IITl分片切除术，虽没有导致较高的复发率，但病灶残留率及并发症发生率较整块切除高，术前应做认真细致的评估。

Objective To evaluate the efficacy and safety of endoscopic mucosal resection （EMR） in the treatment of colorectal adenoma（CRA）. Methods The clinical data of 35 cases of color- ectal adenoma underwent endoscopic mucosal resection from February 2009 to December 2012 were ana- lyzed retrospectively, the flat adenomas with diameter ≥ 10 mm were selected as objects. Its clinical man- ifestations, lesion location, lesion size, treatment, endoscopic features and pathological features were an- alyzed, the rate of residual disease, the incidence of complications, and local recurrence rate were cacu- lated. Results The average age of the patients was （61 ± 12） years old, 38 lesions were found in 35 pa- tients. The average size of lesions was （ 18 ± 8 ） mm. Lesions mostly located in the appendix / ascending colon（44.7% , 17/38）. Monoblock resection accounting for 60. 5%. Lesion with diameter larger than 20 mm had higher removal rate of fragmentation（ P 〈 0. 01 ） and residual disease rate after resection（P 〈 0. 05 ）. Endoscopic complete resection rate was 92. 1%. Low-level intraepithelial neoplasia the majority histological classification, accounting for 78.9%. The complication rate was 5.7%, the average follow- up time was （16 -＋ 9） months, the local recurrence rate was 17.2% （5/29）. Conclusions EMR in the treatment of flat colorectal adenoma is effective and safe. Slice resection in lesions larger than 20 mm doesn＇ t lead to higher relapse rate, but the rate of residual disease and the incidence of complications are higher than monoblock resection, careful assessment should be done before surgery.