大肠癌精筛中内镜黏膜切除术对结直肠进展期腺瘤的诊治价值

Endoscopic mucosal resection for colorectal advanced adenoma in accurate screening of colorectal cancer

目的探讨内镜黏膜切除术(EMR)在大肠癌精筛中诊治结直肠进展期腺瘤的临床价值。方法收集2016-01～2017-05广州市中西医结合医院结肠镜活检诊断为结直肠广基或亚蒂进展期腺瘤52例,行EMR切除病灶,并行病理学检查明确诊断,随访观察治疗效果和安全性。结果 47例病变予EMR切除,5例予内镜黏膜分片切除术(EPMR)切除,术中出血5例,均<20 ml,术后无迟发型出血及穿孔发生。所有病变一次性整块切除率为90. 4%(47/52),组织治愈性切除率为88. 5%(46/52);术后病理提示绒毛状腺瘤或管状绒毛状腺瘤伴低级别上皮内瘤变(LGD) 38例(73. 1%),绒毛状腺瘤或管状绒毛状腺瘤伴高级别上皮内瘤变(HGD) 12例(23. 1%),另有2例(3. 8%)黏膜下癌转外科手术治疗,但术后病变肠段未发现肿瘤组织残留和淋巴结转移。50例患者术后随访3～15月(中位随访9个月)未见复发。结论 EMR诊治进展期腺瘤安全有效,在大肠癌精确筛查中能发挥关键的诊治价值。

Objective To investigate the clinical value of endoscopic mucosal resection for colorectal advanced adenoma in accurate screening of colorectal cancer. Methods A total of 52 patients who were diagnosed with colorectal advanced adenoma by colonoscopy, and demanded endoscopic resection in the Endoscopy Room of Guangzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2016 to May 2017 were collected. The lesion size, morphology and operation methods of the gland, complications and postoperative pathological types were investigated. Results The lesions were resected by EMR in 47 cases, and by EPMR（endoscopy piecemeal mucosal resection） in 5 cases. 5 cases developed intraoperative bleeding, less than 20 ml. No cases occurred delayed bleeding and perforation. The lesions were completely resected with an en bloc resection rate of 90.4%（47/52）, and a histological curative resection rate of 88.5%（46/52）. The pathological findings showed that the lesions were tubular adenoma or tubular villous adenoma with low-grade dysplasia（LGD） in 38 cases（73.1%）, tubular adenoma or tubular villous adenoma with high-grade dysplasia（HGD） in 12 cases（23.1%） and submucosal carcinoma in 2 cases（3.8%） which was resected by surgery and both lateral and basal margins of the specimens were free of tumor cells and without surrounding lymph node metastasis. 50 patients were followed up for 3 to 15 months and the median follow-up time was 9 months. No residual tumors and recurrence were found during the period of follow-up. ConclusionEndoscopic mucosal resection is safe and effective for colorectal advanced adenoma, and plays a key role in the accurate screening of colorectal cancer.