内镜下黏膜切除术治疗结肠广基息肉的临床可行性分析

Endoscopic mucosal resection of sessile colonic polyps clinical feasibility analysis

目的探讨结肠较大广基息肉采用内镜下黏膜切除术治疗的可行性及临床效果。方法该研究为前瞻性分析,选取2013年9月—2015年7月符合入组标准的病人135例,共158个息肉标本,均行内镜下黏膜切除术,将手术切除后的病理组织送病理科进行检查,了解其病理分型情况,记录手术的并发症及成功率,以评价内镜下黏膜切除术治疗结肠较大广基息肉的可行性及有效性。结果 135例病人的结肠广基息肉基底直径均在1 cm以上,>1~≤2 cm者90个,>2~≤3 cm 40个,>3 cm者28个,一次性完整切除134例病人,1例病人转外科手术治疗,成功率达99.26%;出现即刻出血10 m L以上27例,术后迟发性出血13例,经术中处理和保守治疗后均得到痊愈,治疗时间平均为(41±15)min;病理检查管状腺瘤63个,管状-绒毛状腺瘤70个,绒毛状腺瘤25个;30个伴高级别上皮内瘤变,42个伴低级别上皮内瘤变,基底切缘组织无病变残留。经过术后1年的临床随访,未发现残留及复发现象。结论内镜下黏膜切除术治疗结肠较大广基息肉局部复发率低,是安全可行的治疗方法。

Objective To investigate the feasibili ty and cl in ic al effect of endoscopic mucosal re se ct ion trea tment for the large sessile co-lonic polyps. Methods This study was a prospective analysis. The el igible pat ien ts from our hospi tal in September 2013 -July 2015 were enrolled in standard 135 cases,with a total of 158 polyps specimens. All the cases carried out endoscopic mucosal resection. The surgical resection histopathological specimens were sent to pathology inspection, to understand the pathological type of each case. The recording and the success rate of surgical complications were evaluated. The feasibility and effectiveness of internal evaluation to endo-scopic mucosal resection of large sessile colonic polyps were also investigated. Results 135 ca se s of pat ien ts with colon polyps wide base diameter were more than 1 cm,〉 1 -≤2 cm in 90 ,〉 2-≤3 cm in 40 , 〉 3 cm in 28 , a one-time complete re se ct ion 134 pa-tients ,1 patient transfer surgery,the success rate of 99. 26% ; appear instantly hemorrhage 10 mL or more in 27 cases ,13 cases appea red delayed bleeding after intraoperative treatment and conservative treatment were cured. The average treatment time was（41 ± 15） min; pathological examination of 63 of tubular adenoma, tubular villous adenoma in 70, fluff adenoma 25 ; 30 with in tra epi the lial high-level in -traepithelial neoplasia in the epithelium with low grade in 42 ,no tissue substrate edge of residual disease. After 1 year after clinical fol-low-up, residual and recurrent phenomenon was observed. Conclusions The local re cu rren cerate of endoscopic mucosal resection of large sessile colonic polyps is low,which is asafe and feasible treatment.