Objective To evaluate the efficacy and safety of endoscopic mucosal resection (EMR) in the treatment of colorectal adenoma(CRA).Methods The clinical data of 35 cases of colorectal adenoma underwent endoscopic mucosal resection from February 2009 to December 2012 were analyzed retrospectively,the flat adenomas with diameter≥ 10 mm were selected as objects.Its clinical manifestations,lesion location,lesion size,treatment,endoscopic features and pathological features were analyzed,the rate of residual disease,the incidence of complications,and local recurrence rate were caculated.Results The average age of the patients was(61 ± 12) years old,38 lesions were found in 35 patients.The average size of lesions was(18 ± 8) mm.Lesions mostly located in the appendix / ascending colon(44.7％,17/38).Monoblock resection accounting for 60.5％.Lesion with diameter larger than 20 mm had higher removal rate of fragmentation(P ＜0.01) and residual disease rate after resection(P ＜ 0.05).Endoscopic complete resection rate was 92.1％.Low-level intraepithelial neoplasia the majority histological classification,accounting for 78.9％.The complication rate was 5.7％,the average followup time was (16 ±9) months,the local recurrence rate was 17.2％ (5/29).Conclusions EMR in the treatment of flat colorectal adenoma is effective and safe.Slice resection in lesions larger than 20 mm doesn' t lead to higher relapse rate,but the rate of residual disease and the incidence of complications are higher than monoblock resection,careful assessment should be done before surgery.%目的 评价内镜下黏膜切除术(EMR)治疗结直肠腺瘤(CRA)的疗效和安全性.方法 回顾性分析2009年2月至2012年12月35例CRA行EMR治疗患者的资料,选择直径≥10 mm的平坦型腺瘤为研究对象,分析其临床表现、病变部位、大小、治疗经过及内镜和病理特征,统计病灶残留率、并发症发生率以及局部复发率.结果 患者平均年龄(61±12)岁,35例患者中发现38个病灶,病变平均(18±8)mm,病变多数位于盲肠/升结肠(44.7％,17/38).整块切除术占60.5％,病变直径＞20mm的病灶具有较高的分片切除率(P＜0.01)和切除后病灶残留率(P＜0.05).内镜下完整切除率达到92.1％.组织学分类中低级别上皮内瘤变占多数(78.9％),并发症发生率为5.7％,平均随访时间(16±9)个月,局部复发率为17.2％(5/29).结论 EMR治疗平坦型CRA是有效和安全的.病变＞20mm分片切除术,虽没有导致较高的复发率,但病灶残留率及并发症发生率较整块切除高,术前应做认真细致的评估.
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