【摘要】 目的评价内镜下黏膜切除术(EMR)治疗结直肠息肉的疗效、安全性。方法回顾性分析368例结直肠息肉的临床特点以及应用EMR治疗的疗效和安全性。结果 368例患者共669枚息肉,直径0.5～2.5 cm,平均(1.2±0.7)cm,均顺利完成EMR治疗。一次性整块切除660枚,分块切除9枚息肉。术中出血18例,术后迟发性出血2例,均内镜下止血成功。穿孔1例,予金属铗夹闭处理,术后第3天突发急性腹膜炎症状,转外科手术治疗。术后病理诊断腺瘤合并低级别上皮内瘤83例,高级别上皮内瘤变52例。黏膜内癌11例,其中2例病变切缘显微镜下有癌瘤残留,6例术后1周复查肠镜见肉眼残留,均转外科追加手术治疗。术后随访12～24个月,复发42例。EMR治疗结直肠息肉,一次性整块切除率为98.7%,残留率为0.9%,并发症发生率为0.81%,2年复发率为11.4%。结论 EMR治疗结直肠息肉一次性整块切除率高、并发症少,且安全性高、术后复发率低,值得临床进一步推广应用。更多还原

【Abstract】 Objectives To investigate the efficacy and safety of endoscopic mucosal resection(EMR) for colorectal polyps.Methods To analyze clinical features together with the efficacy and safety of EMR for colorectal polyps in 368 cases retrospectively.Results In 368 patients,a total of 669 polyps,0.5 to 2.5 cm in diameter with an average of(1.2±0.7) cm,were treated with EMR successfully.660 polyps were resected in one piece and 9 polyps were resected in pieces.Eighteen cases and 2 cases were bleeding during and after operation,and the hemostasis was successful under endoscope.One case of perforation was treated with metal clip clamping.On the 3 rd day after operation,symptoms of acute peritonitis occurred and the patient was transferred to surgical treatment.There were 83 cases of low-grade intraepithelial neoplasia,52 cases of high-grade intraepithelial neoplasia,11 cases of intramucosal carcinoma.There were 11 cases of intramucosal carcinoma,of which 2 cases had residual tumor in margin under microscope,and 6 cases were re-examined with naked eye residue by colonoscopy 1 week after resection,and all of them were transferred to surgery department for additional surgical treatment.After 12-24 months follow-up,42 cases were recurrent.As for EMR treatment,the en bloc resection rate can reach as high as 98.7%,with a residual rate of 0.9%,a complication rate of 0.81%,and a 2-year recurrence rate of 11.4%.Conclusion EMR can be used in the treatment of colorectal polyps with high en bloc resection rate,low complication rate,together with high safety and low recurrence rate.It is worthy of further clinical application.更多还原