内镜分片黏膜切除术治疗巨大结直肠平坦型病变的临床评价及复发率随访

Clinical evaluation and recurrence of endoscopic piecemeal mucosal resection in treatment of huge colorectal flat lesions

目的 评价内镜分片黏膜切除术（endoscopic piecemeal mucosal resection,EPMR）治疗巨大结直肠平坦型病变的疗效、安全性及应用价值,并随访观察其复发率.方法 经术前内镜检查评估及病理证实,符合内镜切除适应证,采用EPMR切除46例直径≥30 mm结直肠平坦型病变,均为侧向发育型肿瘤（LST）,术后标本全部行精确的病理学评价.结果 46例结直肠LST患者中,病灶位于直肠38例,占82.6％,完全切除率93.5％ （43/46）,切除治愈率97.8％（45/46）.术后出血发生率为4.3％,均经内镜止血成功,无1例发生穿孔.术后病理均为腺瘤,伴低级别上皮内瘤变30例,伴高级别上皮内瘤变10例,黏膜内癌6例.全组患者随访3～ 96个月,仅2例复发,复发率4.3％,再次内镜处理获愈.结论 EPMR是治疗巨大结直肠平坦型病变安全、有效的方法,掌握切除方法和技巧,可以完全切除病变,减少残留及复发率.

Objective To evaluate the efficacy, safety and application value of endoscopic piecemeal mucosal resec- tion （EPMR） in treatment of huge eolorectal flat lesions and to observe the recurrence rate. Methods EPMR was performed in 46 cases of colorectal flat lesions larger than 30 mm in diameter laterally spreading tumor （LST） after the preoperative endoscopy and pathology and postoperative samples underwent precise pathological evaluation. Results Among 46 cases of eoloreetal LST patients, lesions were located in rectum in 38 cases, accounting for 82.6% ; the total resection rate was 93.5% （43/46） , resection of the cure rate was 97.8% （45/46）. Postoperative bleeding occurrence （4.3 % ） were treated by endoscopic hemostasis and perforation didn＇ t occur. Postoperative pathology were all adenomas with low grade intraepithelial neoplasia in 30 eases, high grade intraepithelial neoplasia in 10 eases, intramucosal carci- noma in 6 cases. All patients were followed up for 3～96 months, the reeurrence rate was 4.3%. Conclusion EPMR is proved to be a safe and effective method for huge colorectal flat lesions. It can completely excise of the lesions, reduce residual and recurrence rate.