内镜下黏膜切除术治疗结肠憩室腺瘤的疗效分析  

Efficacy of Endoscopic Mucosal Resection in Treatment of Colonic Diverticulum Adenoma

作　　者：刘斌 陈杏林 祁琴琴 蔡媛媛 魏可 王哲民 陈柳勇 LIU Bin;CHEN Xinglin;QI Qinqin;CAI Yuanyuan;WEI Ke;WANG Zhemin;CHEN Liuyong(Department of Gastroenterology,the First People′s Hospital of Hangzhou Lin′an District,Hangzhou,311300)

机构地区：[1]杭州市临安区第一人民医院消化内科,311300

出　　处：《胃肠病学》2024年第1期36-39,共4页Chinese Journal of Gastroenterology

摘　　要：背景:当结肠腺瘤累及憩室时,憩室内的炎症状态会增加腺瘤性病变的异型增生风险,故结肠憩室腺瘤更易发生恶变,需切除腺瘤以避免结肠癌结局,改善预后。目的:探讨内镜下黏膜切除术(EMR)治疗结肠憩室腺瘤的有效性和安全性。方法:连续收集2018年6月—2022年1月于杭州市临安区第一人民医院接受EMR治疗的14例结肠憩室腺瘤(憩室内部或憩室附近)病例,分析其临床特征和结局。主要结局指标为并发症,包括出血、穿孔和电凝综合征,次要结局指标为整块切除率、完全切除率和局部复发率。结果:14例结肠憩室腺瘤患者中,A型(憩室旁型)13例,B型(憩室内型)1例;病灶直径为(0.76±0.25)cm;手术时间为(19.67±5.33)min;组织学类型以管状腺瘤为主,病理性质以上皮内瘤变多见。1例(7.1%)患者发生迟发性出血,1例(7.1%)发生电凝综合征,未见穿孔事件。整块切除率、完全切除率均为100%。术后1年内10例复查结肠镜,均未发现局部复发。结论:EMR治疗结肠憩室腺瘤具有安全、有效的特点,但抗血小板药服用史和同时累及阑尾孔、憩室的结肠腺瘤患者需警惕术后并发症。Background:When colonic adenoma involves diverticulum,inflammation in the diverticulum will increase the risk of adenomatous dysplasia.Therefore,patients with colonic diverticulum adenoma are at a higher risk of colon cancer,and the adenoma needs to be resected to avoid poor outcome and improve prognosis.Aims:To explore the efficacy and safety of endoscopic mucosal resection(EMR)in treatment of colonic diverticulum adenoma.Methods:Fourteen consecutive cases of colonic adenoma near or involving a diverticulum treated by EMR from Jun.2018 to Jan.2022 at the First People′s Hospital of Hangzhou Lin′an District were collected,and their clinical characteristics and outcomes were analyzed.The primary outcome was complications,including bleeding,perforation,and electrocoagulation syndrome,while the secondary outcomes were the en bloc resection rate,complete resection rate and local recurrence rate.Results:Among the 14 patients with colonic diverticulum adenoma,13 were type A(near a diverticulum)while 1 was type B(involving a diverticulum).The diameter of the lesion was(0.76±0.25)cm,and the operation time was(19.67±5.33)minutes.The main histological type was tubular adenoma,and the pathological results was intraepithelial neoplasia in most of the cases.Delayed hemorrhage was observed in 1 patient(7.1%),and electrocoagulation syndrome in 1 patient(7.1%).No perforation event occurred.The en bloc resection rate and complete resection rate were 100%.Ten patients accepted reexamination of colonoscopy within 1 year after surgery,and no local recurrence was found.Conclusions:EMR is safe and effective for treatment of colonic diverticulum adenoma.However,patients using antiplatelet drugs and adenoma involving both appendiceal orifice and diverticulum should be alert to postoperative complications.

关 键 词：内镜下黏膜切除术 结肠腺瘤 憩室 并发症 治疗 

分 类 号：R735.35[医药卫生—肿瘤]