基于内镜下黏膜切除术的中西医治疗大肠息肉研究进展

Research progress of endoscopic mucosal resection and different Traditional Chinese Medicine therapy in the treatment of colorectal polyps

大肠息肉(colorectal polyps,CRP)是指结肠、直肠黏膜上皮所有伸入肠腔的赘生物,可呈单发或多发,包括肿瘤性及非肿瘤性的息肉,临床可以腹痛、腹泻、便血等症为主要表现,可归属于中医学"肠覃"范畴[1-3]。据统计,大肠癌(colorectal cancer,CRC)仍然是全球癌症死亡的主要原因,其中50%~70%的CRC是由"腺瘤-癌"途径发展而来的,因此早期发现和治疗CRP,特别是内镜下切除高危腺瘤。

Endoscopic mucosal resection is considered to be the standard method for the resection of 10-20 mm colorectal polyps and the first choice to prevent it from developing into colorectal cancer, and it is a mature endoscopic treatment for colorectal polyps. Traditional Chinese Medicine has important application value in promoting the recovery after polypectomy, especially in preventing the recurrence of polyps, which is worth further digging and popularizing in clinic. However, at present, the clinical application of endoscopic mucosal resection is still not unified at home and abroad, and the reports on the treatment of colorectal polyps by combination of traditional Chinese and western medicine are still rare. in order to further promote and promote the development of endoscopic mucosal resection and explore the feasible scheme of traditional Chinese medicine intervention in the treatment of colorectal polyps, the author specially studies the relevant literature at home and abroad in the past 10 years from Pubmed, China knowledge Network and VIP periodical database. It was found that endoscopic mucosal resection was an ideal treatment for sawtooth lesions with diameter ≥ 10 mm, rectal neuroendocrine swelling with diameter ≤ 8 mm, benign sessile colonic polyps with diameter ≥ 20 mm, rectal lateral developmental tumors and so on. As an alternative to CEMR, UEMR and EMR+ have a broad development prospect in the resection of colorectal polyps. Different internal and external treatments of traditional Chinese medicine have unique effects on promoting postoperative repair of intestinal mucosa, prevention and control of postoperative complications and prevention of recurrence. The perioperative report of Traditional Chinese Medicine and integrated traditional Chinese and western medicine in the treatment of intestinal polyps remains to be further studied.