摘要
目的 探讨内镜黏膜切除术治疗结直肠局灶性隆起性病变的有效性、安全性、疗效及影响原位复发的危险因素。方法 对2009年1月至2014年12月在上海交通大学医学院附属同仁医院内窥镜室就诊的450例共626处结直肠单发或多发隆起性病灶患者进行内镜黏膜切除术,统计病理结果 及并发症情况,并结肠镜随访了180例患者术后6~36个月。观察术后病灶原位复发情况。结果 450例患者中,病灶大小：Φ≤1.0 cm 278枚,1.0〈Φ≤2.0 cm 280枚,2.0 cm〈Φ≤3.0 cm 52枚,Φ〉3.0 cm 16枚。病灶病理类型：结肠癌7例,低级别上皮内瘤变314例,高级别上皮内瘤变43例,单纯腺瘤23例,非腺瘤性息肉44例,间质来源肿瘤及其他19例。病灶均经EMR完整切除。11例患者出现包括出血、穿孔等手术发症。180例随访患者经6~36个月内镜随访,出现病灶原位复发39例（8.67%）,其中12个月内复发32例（32/39,82.05%）,Logistic回归分析示病灶个数及结直肠肿瘤手术史为原位复发的危险因素（P〈0.05）。结论 EMR是治疗结直肠隆起性病变安全、简便、有效的方法 ;对于存在高危因素患者应术后6个月内复查结肠镜。
Objective To assess the safety and efficacy of endoscopic mucosal resection （EMR） in treatment of elevated colorectal lesions, and the risk factors influencing the local recurrence. Methods Total 450 patients with 626 colorectal lesions, who underwent EMR from Jan 2009 to Dec 2012 in the endoscopic center of Tongren Hospital, were enrolled. The information of histological pathology and postoperative complication were documented. Among 450 patients, 180 patients had regular follow-up in our center, and the local recurrences were observed and recorded. Chi-square test and Logistic regression analysis were used for statistical analysis. Results The number of lesions Ф≤ 1.0cm, 1.0 〈 Ф≤2.0 cm, 2.0 〈 Ф≤3.0 cm and Ф 〉3.0 cm was 278, 280, 52 and 16, respectively. Histologically, adenocarcinoma was reported in 7 patients, low-grade intraepithelial neoplasia in 314 patients, high-grade intraepithelial neoplasia in 43 patients, adenomatous polyp in 23, non-adenomatous polyp in 44, and stromal tumor or other histopathological diagnosis in 19 patients. All lesions were resected by EMR en bloc. Among 450 patients, 11 had postoperative complication, including bleeding or perforation. Among 180 patients who were followed-up for 6- 36 months, local recurrence was discovered in 39 cases, including 32 cases with the recurrence within 12 months. Logistic regression showed that the number of lesions and the history of colorectal tumor surgery were risk factors of local recurrence （ P 〈 0. 05 ）. Conclusion EMR is a safe and effective procedure to treat elevated colorectal lesions. For the patients with high risks of local recurrence, the endoscopic follow-up within 6 months is essential.
出处
《同济大学学报（医学版）》
CAS
2016年第4期65-69,共5页
Journal of Tongji University(Medical Science)
基金
上海市卫计委面上项目(201440426)
关键词
内镜黏膜切除术
结直肠
隆起性病灶
endoscopic mucosal resection
colorectum
colo-rectal elevated lesions
