摘要
目的探讨经内镜下黏膜切除术(EMR)治疗结直肠息肉的临床、病理及镜下特征,评估此术式的疗效和安全性,并指导医生进行疾病的诊断及治疗。方法取该院2014年8月-2015年8月行EMR切除息肉的437例(687枚)患者的临床病理资料进行回顾性分析,按照腺瘤癌变以及高危性腺瘤-低危性腺瘤-非腺瘤性息肉分组法,以年龄、性别、临床表现以及息肉内镜、病理特征等指标为变量进行统计分析,观察EMR治疗息肉的临床效果,评估其安全性。结果息肉内镜下检出率为48.28%,进行EMR治疗的息肉占全部息肉的34.90%,其中高危腺瘤占17.08%,从非腺瘤性息肉到高危性腺瘤,随着癌变可能性的增加,息肉发生部位从近端结肠向远端结肠转移,其形态更容易表现为有蒂息肉,且黏膜分叶和黏膜改变发生率逐渐增加。大肠息肉癌变与息肉有蒂、分布在远端结肠、直径大于1.0 cm、腺瘤含绒毛样成分、息肉黏膜分叶、充血、粗糙和糜烂有关。EMR治疗息肉,一次性切除率为99.70%,并发症发生率为1.14%。结论高危性腺瘤和癌变腺瘤在结直肠分布及内镜下表现中存在一定的特征,该院针对大小为0.5~3.0 cm的息肉,采用EMR联合钛夹治疗息肉的临床效果显著,并发症少,可有效阻断腺瘤-大肠散发性癌这一演化进程,是防治结直肠癌的有效手段。
Objectives To investigate the clinical, pathological and endoscopic characteristics of colorectal polyps treated by endoscopic mucosal resection （EMR）, then evaluate its therapeutic effect and security, and analyze its signifcance in diagnosis and treatment. Methods Clinical and pathological data of 437 patients （687 lesions）, who underwent EMR from August, 2014 to August, 2015 were collected. A retrospective analysis was made, and lesions were statistically analyzed by variables such as age, sex, endoscopic features and clinical and pathological characteristics, and so on, according to the group procedure of adenoma cancerization and ‘high risk adenomas - low risk adenomas - non-adenoma polyps’ to observe the curative effect and safety on EMR. Results 48.28% of the patients who received colonoscopy examines were detected with polyps, and 34.90% of them were operated EMR, including advanced adenomas, which were 17.08% of the total quantity. From non-adenoma to advanced adenoma, with a increasing possibility of carcinogenesis, the location of polyps are transferred from proximal colon to distal colon and lesions are readily to be pedunculated ones with a higher level of mucosal lobulation and other kinds of mucosal changing. The degeneration of the colorectum is associated with pedunculated polyps, distal colorectal polyps, the size （〉1.0 cm）, adenomas containing villous structures and mucosal lobulation. As for EMR treatment, the en bloc resection rate can reach as high as 99.70%, with a complication rate of 1.14%. Conclusions Some special characteristics can be found in the site and the endoscopic feature of advanced adenomas and degenerated adenomas. To polyps sizing in 0.5 ~？3.0 cm, EMR with endoclips has a remarkable effect and a low complication incidence. It can reduce the process of colorectal adenoma degenerates to multiple colorectal adenocarcinoma, which can be regarded as an effective method to prevent and cure the colorectal carcinoma.
出处
《中国内镜杂志》
北大核心
2017年第6期34-39,共6页
China Journal of Endoscopy
关键词
结直肠息肉
腺瘤
内镜下黏膜切除术
回顾性研究
colorectal polyps
adenoma
endoscopic mucosal resection （EMR）
retrospective analysis
作者简介
[通信作者]吴静,E-mail：wujing36@163.com
