长蒂息肉良恶性临床特征分析及内镜下治疗方式的比较  

Benign and malignant characteristic analysis and endoscopic treatment of long-stalked pedicle polyp

作　　者：王佳[1] 刘欢[1] 聂姗 仇承恩 杜召召 崔曼莉 张明鑫 WANG Jia;LIU Huan;NIE Shan;QIU Cheng'en;DU Zhaozhao;CUI Manli;ZHANG Mingxin(Department of Gastroemterology,the First Affiliated Hospital of Xi'an Medical University,Shaanxi Xi'an 710077,China;Sichuan People's Hospital,Sichuan Academy of Medical Sciences,Sichuan Chengdu 610031,China)

机构地区：[1]西安医学院第一附属医院消化内科,陕西西安710077 [2]四川省医学科学院四川省人民医院,四川成都610031

出　　处：《现代肿瘤医学》2023年第19期3604-3609,共6页Journal of Modern Oncology

基　　金：陕西省教育厅专项科研计划项目(编号:22JK0548)。

摘　　要：目的:分析消化道长蒂息肉(蒂部长度大于宽度,头部大于10 mm的息肉)临床特征,对比内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)和内镜黏膜切除术(endoscopic mucosal resection,EMR)切除长蒂息肉的效果和安全性。方法:回顾分析了2021年01月至2022年12月我院长蒂息肉患者的临床特征、内镜表现、病理结果和不同治疗方式并发症等数据。结果:研究共纳入长蒂息肉患者57人,其中男性24人,女性33人,共计长蒂息肉61个,平均年龄为(55.33±14.99)岁。长蒂息肉头部平均直径为(17.30±9.65)mm,蒂部长度平均为(14.16±11.11)mm,蒂部宽度平均为(6.30±2.58)mm。85.25%的长蒂息肉生长在结直肠,更常见于左半结肠,约占结直肠总数的65.38%。从病理类型来看,腺瘤性息肉约占50.82%、增生性息肉约占19.67%和传统锯齿状腺瘤约占8.20%。根据不同部位分析发现胃的长蒂息肉以炎性息肉和增生性息肉为主,而腺瘤性息肉则更常见于肠道。共有2个息肉发生癌变,均在肠道。手术方式分为EMR组及ESD组,其中EMR组51个,7个无法评估切缘;ESD组共10个,均能很好的评估切缘情况,但两组在切除完整性方面比较无统计学差异(P>0.05)。在不良事件方面,两组均无迟发性出血发生,ESD组有1个发生穿孔,进行外科修补,两组间比较无统计学差异(P>0.05)。在手术时间方面,EMR平均切除时间为(9.08±4.81)min,ESD平均时间为(31.20±10.56)min(包括封闭创面时间),两组有统计学差异(P<0.05)。结论:长蒂息肉作为息肉的一种类型,更常见于肠道,病理类型以腺瘤性息肉为主。ESD作为息肉的治疗方式之一,没有重大并发症,可以实现整体切除,特别是对于巨型带蒂息肉、疑似癌变的病变。Objective:To analyze the clinical characteristics of long-stalked pedicle polyp(polyp whose pedicle length is larger than width,and a large head>10 mm)of digestive tract,and to compare the effect and safety of removing long-stalked pedicle polyp by ESD and EMR.Methods:The clinical features,endoscopic findings,pathological findings and complications of different treatment methods of long-stalked pedicle polyp in our hospital from January 2021 to December 2022 were retrospectively analyzed.Results:Fifty-seven patients were included in the study,including 24 males and 33 females,and a total of 61 of long-stalked pedicle polyp with an average age of 55.33±14.99 years old.The average head diameter,pedicle length and pedicle width of long-stalked pedicle polyp were(17.30±9.65)mm,(14.16±11.11)mm and(6.30±2.58)mm.85.25%of long-stalked pedicle polyp are found in the colorectum,more commonly in the left half of the colon,accounting for 65.38%of the total colorectal population.In terms of pathological types,adenomatous polyp accounted for 50.82%,hyperplastic polyp 19.67%and traditional serrated adenoma 8.20%.Inflammatory polyp and hyperplastic polyp were the main polyp in the stomach,while adenomatous polyp were more common in the intestine.A total of 2 polyp became cancerous,all in the intestine.The 51 surgical methods were divided into EMR group and ESD group.In the EMR group,with 7 could not evaluate the incisal margin.In the ESD group with 10,all could evaluate the incisal margin well.There was no statistical difference between the two groups in the excision integrity(P>0.05).In terms of adverse events,there was no delayed bleeding in the two groups,and 1 of perforation in the ESD group underwent surgical repair,and there was no statistical difference between the two groups(P>0.05).The mean EMR resection time was(9.08±4.81)min,and the mean ESD resection time was(31.20±10.56)min(including wound closure time),and there was statistical difference between the two groups(P<0.05).Conclusion:As a type of polyp,long-stalk

关 键 词：息肉切除术后出血 带蒂息肉 息肉样早期结肠癌 浸润深度 息肉切除术 

分 类 号：R735.3[医药卫生—肿瘤]