内镜下黏膜切除术治疗结直肠进展期腺瘤

Endoscopic mucosal resection for colorectal advanced adenoma

目的 探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）治疗直径≥1.5 cm结直肠亚蒂及广基进展期腺瘤的安全性及有效性,为EMR治疗较大结直肠进展期腺瘤提供依据。方法 回顾性分析2014年1月-2015年1月陆军总医院消化内镜中心结直肠息肉治疗病例,收集符合纳入标准的结直肠亚蒂及广基进展期腺瘤,以腺瘤大小、位置、病理组织学和形态学为变量,分析腺瘤整块切除和术中出血的影响因素。结果 共收集76例患者106枚腺瘤,男47例,女29例,平均年龄（60.9±10.8）岁;整块切除89枚（84.0%）,术中少量出血23枚（21.7%）,无穿孔及迟发性出血;术后随访观察52枚（49.1%）,平均随访时间（6.4±3.9）个月,仅1枚（2.0%）腺瘤发现可疑残留,术后病理为炎性改变。多因素回归分析发现,组织学分化（OR=3.4,95%CI：1.2-13.2）和腺瘤位于弯曲部位（OR=3.1,95%CI：1.0-12.6）是影响术中出血的主要因素;组织学分化（OR=5.1,95%CI：1.1-23.2）和腺瘤直径≥3.0 cm（OR=28.7,95%CI：1.1-749.8）是整块切除的危险因素。结论 EMR治疗直径≥1.5 cm结直肠亚蒂及广基进展期腺瘤整块切除率高,无迟发性出血、穿孔等严重并发症,是一种安全有效的治疗方法。

Objective To investigate the efficacy and safety of endoscopic mucosal resection （EMR） for sub-pedunculated and broad base colorectal advanced adenoma exceeding or equal to 1.5 cm, to provide clinical data for treatment of large colorectal advanced adenomas with EMR. Methods From Jan. 2014 to Jan. 2015, Colorectal polyps were collected in Digestive Endoscopy Center of PLA Army General Hospital. According to inclusion criteria, sub-pedunculated and broad base colorectal adenomas were collected and diameter, location, histopathology and morphology of these adenomas were analyzed and the related factors of en-block resection and intra-procedural bleeding were analyzed. Results A total of 106 polyps in 76 patients were collected, there were 47 males and 29 females, the mean age was （60.9 ± 10.8） years old; 89 adenomas （84.0%） were en-block resected; 23 adenomas （21.7%） had intra-procedural bleed- ing, no perforation and delayed bleeding occurred. Follow-up was achieved in 52 adenomas （49.1% ） and the mean duration of follow-up was （6.4 ±3.9） months, one suspicious residual lesion was found, histopathology was inflammatory polyp. Multi factor regression analysis results were as follows： histopathology （ OR = 3.4, 95% CI： 1.2± 13.2） and polyps located in the juncture of colons （ OR = 3. 1 , 95% CI： 1.0 - 12.6） were the main factors of intra-procedural bleeding; histopathology （OR=5. 1, 95% CI： 1.1-23.2） and diameter≥3.0 cm （OR =28.7, 95% CI： 1. 1 749.8） were the risk factors of en-block resection. Conclusion EMR is safe and effective for sub-pedunculated and broad base eolorectal advanced adenomas≥ 1.5 cm with high en-block resection rate, without delayed bleeding and perforation.