内镜下黏膜切除术治疗结直肠息肉437例分析

发布时间：2018-05-19 01:15

本文选题：结直肠息肉 + 腺瘤　；参考：《中国内镜杂志》2017年06期

【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。
[Abstract]:Objective to investigate the clinical, pathological and endoscopic features of endoscopic mucosal resection (EMRs) in the treatment of colorectal polyps, to evaluate the efficacy and safety of this procedure, and to guide doctors in the diagnosis and treatment of colorectal polyps. Methods the clinicopathological data of 437 patients with polyps removed by EMR from August 2014 to August 2015 were retrospectively analyzed. According to the classification of adenoma carcinogenesis and high risk adenomatous polyps, age was used. Sex, clinical manifestations, endoscopic and pathological features of polyps were statistically analyzed to evaluate the efficacy and safety of EMR in the treatment of polyps. Results the detection rate of polyps under endoscopy was 48.28%. The polyps treated with EMR accounted for 34.90% of the total polyps, and the high-risk adenomas accounted for 17.08%, from non-adenomatous polyps to high-risk adenomas, with the increase of the possibility of carcinogenesis. The polyps metastasized from the proximal colon to the distal colon, and the morphology of the polyps was more likely to be pedicled polyps, and the incidence of mucosal lobulation and mucosal changes increased gradually. Colorectal polyps with pedicled carcinogenesis and polyps were located in the distal colon with diameter greater than 1.0 cm. Adenoma contained villous components, polyp mucosal lobulation, hyperemia, roughness and erosion related to the treatment of polyps. The one-time resection rate was 99.70 and the complication rate was 1.14. Conclusion High risk adenoma and cancerous adenoma have some characteristics in colorectal distribution and endoscopy. The clinical effect of EMR combined with titanium clip in treating polyps with 0.5 ~ 3.0cm in size is significant and the complications are few. It can effectively block the evolution of adenomatous and sporadic colorectal cancer and is an effective method to prevent and treat colorectal cancer.
【作者单位】：北京大学第九临床医学院消化内科;首都医科大学附属北京世纪坛医院消化内科;
【分类号】：R735.34

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