长蒂息肉良恶性临床特征分析及内镜下治疗方式的比较

Benign and malignant characteristic analysis and endoscopic treatment of long-stalked pedicle polyp

目的:分析消化道长蒂息肉(蒂部长度大于宽度,头部大于10 mm的息肉)临床特征,对比内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)和内镜黏膜切除术(endoscopic mucosal resection,EMR)切除长蒂息肉的效果和安全性。方法:回顾分析了2021年01月至2022年12月我院长蒂息肉患者的临床特征、内镜表现、病理结果和不同治疗方式并发症等数据。结果:研究共纳入长蒂息肉患者57人,其中男性24人,女性33人,共计长蒂息肉61个,平均年龄为(55.33±14.99)岁。长蒂息肉头部平均直径为(17.30±9.65)mm,蒂部长度平均为(14.16±11.11)mm,蒂部宽度平均为(6.30±2.58)mm。85.25%的长蒂息肉生长在结直肠,更常见于左半结肠,约占结直肠总数的65.38%。从病理类型来看,腺瘤性息肉约占50.82%、增生性息肉约占19.67%和传统锯齿状腺瘤约占8.20%。根据不同部位分析发现胃的长蒂息肉以炎性息肉和增生性息肉为主,而腺瘤性息肉则更常见于肠道。共有2个息肉发生癌变,均在肠道。手术方式分为EMR组及ESD组,其中EMR组51个,7个无法评估切缘;ESD组共10个,均能很好的评估切缘情况,但两组在切除完整性方面比较无统计学差异(P>0.05)。在不良事件方面,两组均无迟发性出血发生,ESD组有1个发生穿孔,进行外科修补,两组间比较无统计学差异(P>0.05)。在手术时间方面,EMR平均切除时间为(9.08±4.81)min,ESD平均时间为(31.20±10.56)min(包括封闭创面时间),两组有统计学差异(P<0.05)。结论:长蒂息肉作为息肉的一种类型,更常见于肠道,病理类型以腺瘤性息肉为主。ESD作为息肉的治疗方式之一,没有重大并发症,可以实现整体切除,特别是对于巨型带蒂息肉、疑似癌变的病变。

Objective:To analyze the clinical characteristics of long-stalked pedicle polyp(polyp whose pedicle length is larger than width,and a large head>10 mm)of digestive tract,and to compare the effect and safety of removing long-stalked pedicle polyp by ESD and EMR.Methods:The clinical features,endoscopic findings,pathological findings and complications of different treatment methods of long-stalked pedicle polyp in our hospital from January 2021 to December 2022 were retrospectively analyzed.Results:Fifty-seven patients were included in the study,including 24 males and 33 females,and a total of 61 of long-stalked pedicle polyp with an average age of 55.33±14.99 years old.The average head diameter,pedicle length and pedicle width of long-stalked pedicle polyp were(17.30±9.65)mm,(14.16±11.11)mm and(6.30±2.58)mm.85.25%of long-stalked pedicle polyp are found in the colorectum,more commonly in the left half of the colon,accounting for 65.38%of the total colorectal population.In terms of pathological types,adenomatous polyp accounted for 50.82%,hyperplastic polyp 19.67%and traditional serrated adenoma 8.20%.Inflammatory polyp and hyperplastic polyp were the main polyp in the stomach,while adenomatous polyp were more common in the intestine.A total of 2 polyp became cancerous,all in the intestine.The 51 surgical methods were divided into EMR group and ESD group.In the EMR group,with 7 could not evaluate the incisal margin.In the ESD group with 10,all could evaluate the incisal margin well.There was no statistical difference between the two groups in the excision integrity(P>0.05).In terms of adverse events,there was no delayed bleeding in the two groups,and 1 of perforation in the ESD group underwent surgical repair,and there was no statistical difference between the two groups(P>0.05).The mean EMR resection time was(9.08±4.81)min,and the mean ESD resection time was(31.20±10.56)min(including wound closure time),and there was statistical difference between the two groups(P<0.05).Conclusion:As a type of polyp,long-stalked pedicle polyp is more common in the intestine,and the pathological type is mainly adenomatous polyp.As one of the treatment methods of polyp,ESD can achieve overall resection without major complications,especially for large pedicled polyp or suspected cancer.