内镜黏膜切除术在诊治老年结直肠广基隆起性病变患者中的价值

摘要

Objective To investigate the clinical effect of endoscopic mucosal resection(EMR)for elderly patients with colorectal sessile protuberant lesions.Methods A total of 78 elderly patients,aged 50 to 78(63.4 ±9.2)years, ranging from with colorectal sessile protuberant lesions verified by colonoscopy in our hospital from January 2015 to January 2017 were enrolled in this study.All of them underwent EMR.Size and morphology of lesions, operation methods, complications, and pathological types were investigated. The patients were followed up for at least 3 months.Results There were 72 cases receiving EMR,and 3 cases of type Ⅱa+Ⅱc and 3 cases of laterally spreading tumors(LSTs)undergoing endoscopy piecemeal mucosal resection(EPMR).Eight cases experienced intra-operative bleeding,with an amount of less than 20 ml.No delayed bleeding or perforation occurred.The lesions were completely resected with an enbloc resection rate of 92.3%(72/78), and the histological curative resection rate was 91%(71/78).Post-operative histopathology confirmed that there were 8 cases(10.3%)of hyperplastic polyp,58 cases(74.3%)of tubular adenoma or tubular villous adenoma with low-grade dysplasia(LGD)and 10 cases(12.8%)with high-grade dysplasia(HGD), and 2 cases (2.6%)of submucosal carcinoma.No tumor residual or recurrence was found during the follow-up of 12(3-24)months among the 68 followed patients.Conclusion EMR is safe and effective in treatment of colorectal sessile protuberant lesions in the elderly,and should be promoted in clinical practice.%目的 评价内镜黏膜切除术(EMR)在诊治老年结直肠广基隆起性病变患者中的临床价值.方法 入选2015年1月至2017年1月经广州市中西医结合医院内镜室结肠镜检出的广基隆起性病变患者78例,年龄50~78(63.4±9.2)岁.通过EMR切除病灶,术中记录病变大小、形态以及手术操作方法、并发症、病理类型等信息.至少随访3个月.结果 72例病变均予标准EMR切除,3例Ⅱa+Ⅱc病变及3例LST病变予EPMR切除.术中出血8例,出血量均<20ml.所有患者术后均无迟发性出血及穿孔发生;所有病变一次性整块切除率为92.3%(72/78),组织治愈性切除率91.0%(71/78).术后病理提示增生性息肉8例(10.3%),管状腺瘤或管状绒毛状腺瘤伴低级别上皮内瘤变(LGD)58例(74.3%),管状腺瘤或管状绒毛状腺瘤伴高级别上皮内瘤变(HGD)10例(12.8%),黏膜下癌2例(2.6%).共随访68例患者,中位随访时间12(3~24)个月,均未见复发.结论 EMR诊治老年结直肠广基隆起性病变患者安全、有效,值得推广.