目的探讨结直肠无蒂锯齿状病变的内镜下特点。方法回顾性分析我院2020年1月至2022年7月完成肠镜检查者,所有患者均在发现结肠息肉时立即予以切除治疗并送活检,分析无蒂锯齿状息肉(SSL)的临床及内镜特征,切除方式等。结果共完成筛查性结...目的探讨结直肠无蒂锯齿状病变的内镜下特点。方法回顾性分析我院2020年1月至2022年7月完成肠镜检查者,所有患者均在发现结肠息肉时立即予以切除治疗并送活检,分析无蒂锯齿状息肉(SSL)的临床及内镜特征,切除方式等。结果共完成筛查性结肠镜检查36904例,锯齿状息肉患者4876例,其中无蒂锯齿状病变284例,SSL检出率(SDR)0.77%,SSL占锯齿状息肉比例约5.8%,左半结肠SSL构成比为28.5%,右半结肠SSL构成比为71.5%,直径≤5 mm 29.6%,6~9 mm 45.5%,10~19 mm 18.4%,≥20 mm 6.5%。其中41.2%SSL合并腺瘤,高危腺瘤占13.4%,低危腺瘤占27.8%,33.5%同步多发SSL,6%SSL伴异型增生。SSL的切除方式选择,冷切除占60.2%,内镜下黏膜切除术(EMR)为29.9%,内镜下黏膜剥离术(ESD)为8.1%,外科切除为1.8%。结论锯齿状病变的检出率可能在筛查性结肠镜检查中被低估了,因此,我们需要结合更多的方式以提高锯齿状病变的检出率。展开更多
Surgical technique impacts both local tumor stage and risk of local recurrence in Wilms’tumor. A surgical quality assurance program was part of National Wilms’Tumor Study-5 to assess protocol compliance. Surgical ch...Surgical technique impacts both local tumor stage and risk of local recurrence in Wilms’tumor. A surgical quality assurance program was part of National Wilms’Tumor Study-5 to assess protocol compliance. Surgical checklists, operative, and pathology reports were reviewed concurrently to arrive at the final local tumor stage. If a protocol violation occurred, a letter was sent to the responsible surgeon. Tumor laterality, extent, type of resection, contralateral exploration, node involvement, spills, and local recurrence were reviewed. Relative risk and logistic regression analyses were performed. There were 1305 nephrectomies. Lymph node sampling was not performed in 117 (9%) patients: stage I, 41 (11.5%), stage II, 57 (12%), and stage III, 19 (4%). Of importance, 41%(187/457) of stage III cases were designated stage III solely on the basis of positive lymph nodes. Tumor spill occurred in 19.3%(253/1305) of children. Fifty-four local spills were in stage II tumors and 97 in stage III. Diffuse spill occurred in 102 patients with stage III tumors. Seventeen preoperative and 13 intraoperative biopsies were performed. Intraoperative tumor rupture was the most common cause of tumor spill accounting for 139 (55%) spills. Nineteen (7.5%) children were upstaged, receiving more intensive therapy because of spill. Included in the group were 3 of 17 preoperative biopsies and 5 of 13 intraoperative biopsies. Spills (13/253)were determined to be avoidable. Eight were biopsies, 5 because tumor was transected in the renal vein (4) or ureter (1). In stage II patients where lymph nodes were not sampled, there is an increase in local relapse rate that did not achieve statistical significance because of the small number of events. Although most surgeons complied with the surgical guidelines, numerous deviations were identified including failure to sample lymph nodes (117 cases) and unnecessary biopsies leading to tumor spill (30 cases). Protocol violations have an adverse im-pact on tumor staging, potentially increasing the risk for local tumor recurrence or intensity and toxicity of therapy.展开更多
文摘目的探讨结直肠无蒂锯齿状病变的内镜下特点。方法回顾性分析我院2020年1月至2022年7月完成肠镜检查者,所有患者均在发现结肠息肉时立即予以切除治疗并送活检,分析无蒂锯齿状息肉(SSL)的临床及内镜特征,切除方式等。结果共完成筛查性结肠镜检查36904例,锯齿状息肉患者4876例,其中无蒂锯齿状病变284例,SSL检出率(SDR)0.77%,SSL占锯齿状息肉比例约5.8%,左半结肠SSL构成比为28.5%,右半结肠SSL构成比为71.5%,直径≤5 mm 29.6%,6~9 mm 45.5%,10~19 mm 18.4%,≥20 mm 6.5%。其中41.2%SSL合并腺瘤,高危腺瘤占13.4%,低危腺瘤占27.8%,33.5%同步多发SSL,6%SSL伴异型增生。SSL的切除方式选择,冷切除占60.2%,内镜下黏膜切除术(EMR)为29.9%,内镜下黏膜剥离术(ESD)为8.1%,外科切除为1.8%。结论锯齿状病变的检出率可能在筛查性结肠镜检查中被低估了,因此,我们需要结合更多的方式以提高锯齿状病变的检出率。
文摘Surgical technique impacts both local tumor stage and risk of local recurrence in Wilms’tumor. A surgical quality assurance program was part of National Wilms’Tumor Study-5 to assess protocol compliance. Surgical checklists, operative, and pathology reports were reviewed concurrently to arrive at the final local tumor stage. If a protocol violation occurred, a letter was sent to the responsible surgeon. Tumor laterality, extent, type of resection, contralateral exploration, node involvement, spills, and local recurrence were reviewed. Relative risk and logistic regression analyses were performed. There were 1305 nephrectomies. Lymph node sampling was not performed in 117 (9%) patients: stage I, 41 (11.5%), stage II, 57 (12%), and stage III, 19 (4%). Of importance, 41%(187/457) of stage III cases were designated stage III solely on the basis of positive lymph nodes. Tumor spill occurred in 19.3%(253/1305) of children. Fifty-four local spills were in stage II tumors and 97 in stage III. Diffuse spill occurred in 102 patients with stage III tumors. Seventeen preoperative and 13 intraoperative biopsies were performed. Intraoperative tumor rupture was the most common cause of tumor spill accounting for 139 (55%) spills. Nineteen (7.5%) children were upstaged, receiving more intensive therapy because of spill. Included in the group were 3 of 17 preoperative biopsies and 5 of 13 intraoperative biopsies. Spills (13/253)were determined to be avoidable. Eight were biopsies, 5 because tumor was transected in the renal vein (4) or ureter (1). In stage II patients where lymph nodes were not sampled, there is an increase in local relapse rate that did not achieve statistical significance because of the small number of events. Although most surgeons complied with the surgical guidelines, numerous deviations were identified including failure to sample lymph nodes (117 cases) and unnecessary biopsies leading to tumor spill (30 cases). Protocol violations have an adverse im-pact on tumor staging, potentially increasing the risk for local tumor recurrence or intensity and toxicity of therapy.
