内镜下黏膜切除术治疗老年及老年前期胃肠道息肉的临床研究

摘要

目的 探讨内镜下黏膜切除术(endoscopic mucosal resection,EMR)对老年及老年前期胃及大肠息肉的治疗效果,并对其临床病理特征、适应证、并发症等进行讨论.方法 2003年10月至2009年10月共完成老年及非老年胃息肉及大肠息肉EMR手术1076例;对切除标本进行病理检查,记录术中及术后发生的并发症及处理情况,术后定期内镜随访1～60月.结果 348处胃息肉经首次或再次 EMR 治疗病变均完整清除,病理示炎性息肉、增生性息肉、腺瘤性息肉分别占62.6%(218/348),27.9%(97/348),9.5%(33/348).935处大肠息肉中892 处病变经首次或再次EMR 治疗病变完整清除,治愈率为 95.4%;23处病变 (2.5%)术后病理示浸润癌再追加外科开腹手术.病理示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占29.1%(272/935),20.9%(195/935),46.2%(432/935),3.9%(36/935),随年龄的增加,腺瘤性息肉的比例逐渐升高(P<0.01).术中出血52例(4.8%),均内镜下止血;术后迟发出血(>24 h) 21例(2.0%),其中15例经内镜下止血,6例经输血及内科保守治疗后止血.无穿孔、感染等并发症发生.随访期间所有病例均无复发.结论 EMR是一种安全和微创的内镜治疗手段,对老年及老年前期胃及大肠息肉治疗的疗效优于传统的内镜下治疗方法.%Objective To investigate the curative effect of endoscapic mucoeal resection(EMR) on gastric and colorectal polyps and to discuss the clinical and pathological features, applications, complications in the seninm and presenium. Methods 348 lesions in 291 patients with gastric polyps and 935 lesions in 785 patients with colorectal polyps were enrolled in this study. EMR was performed with an inject-and-cut technique. Histological results on the resected specimens were analyzed. The follow-up period was 1 ～ 60 months to evaluate the curative effect. The rates of complications and following treatments were recorded. Results 348 lesions were all removed in 291 patients with gastric polyps, and the incidence rate of inflammatory polyps, hyperplastic polyps, and adenomatous polyps was 62. 6％ ( 218/348 ), 27.9％ (97/348), 9. 5％ (33/348) respectively. 935 lesions were removed in 785 patients with colorectal polyps. The complete resections in first st or following EMR procedure were performed on 892 out of 935 lesions. The curative rate was 95.4％. There were 23 cases( 2. 5％ ) transferred to surgery because of the finding of pathological invasive cancers after EMR. The incidence rate of inflammatory polyps, hyperplastic polyps, adenomatous polyps and cancerous adenoma was 29. 1％ (272/935), 20. 9％ (195/935), 46. 2％ (432/935), 3. 9％ (36/935) respectively, and the incidence rate of adenomatous poiypo increased gruadully with age. The bleeding was stopped by applying endoscopic hemestasis treatment in 52 patients (4. 8％ ) who occurred bleeding during EMR procedure. Twenty-one patients (2.0％) occurred delayed bleeding, fifteen of whom were cured by endoscopic hemostasis, and six of whom cured by blood transfusion and internal medicine. No perforation, infection and other complications occurred. No recurrence was found during the follow-up. Conclusions EMR is a safe and minimally invasive therapy, and it is more effective for the treatment of gastric and colorectal polyps in the senium and presenium compared with traditional endoscopic therapy.