内镜黏膜切除术治疗消化道无蒂及亚蒂息肉

目的探讨内镜黏膜切除术（endoscopic mucosal resection,EMR）治疗消化道无蒂及亚蒂息肉的安全性及效果。方法 2010年6月～2012年4月,胃息肉85例（88枚）、大肠息肉62例（113枚）,直径〈1.0 cm 95枚,1.0～2.0 cm 101枚,2.0～3.5 cm 5枚;无蒂72枚,亚蒂129枚。最多一例为5枚。采用黏膜下注射-切除法治疗直径〈2.0 cm的无蒂或亚蒂胃、大肠息肉;透明帽负压吸引切除（EMR-C）治疗直径〉2.0 cm的无蒂胃息肉,圈套困难的直径〈2.0 cm的无蒂及亚蒂胃息肉;分片黏膜切除术（endoscopic picemeal mucosal resection,EPMR）治疗直径〉2.0 cm的亚蒂胃息肉,直径〉2.0 cm的无蒂、亚蒂大肠息肉。结果 1枚胃窦部扁平息肉行EMR-C;5枚直径〉2.5 cm的大肠亚蒂、无蒂息肉行EPMR;其余均行黏膜下注射-切除法。术中、术后无出血、穿孔。术后病理检查增生性息肉69枚,管状腺瘤64枚,炎性息肉47枚,管状绒毛状腺瘤10枚,绒毛状腺瘤5枚,锯齿状腺瘤2枚,腺瘤伴高级别上皮内瘤变2例（2枚）,腺瘤伴局部癌变2例（2枚）。腺瘤伴高级别上皮内瘤变的2例中,1例行肠段切除术,术后病理检查未见病变残留;1例EMR术后6个月未复查。腺瘤伴局部癌变的2例中,1例即行结肠癌根治术,术后病理直肠黏膜局部缺损,未见病变残留,区域淋巴结转移癌;1例拒绝手术,亦未复查。16例胃息肉及10例肠息肉术后1年内镜复查,2例肠息肉术后2年肠镜复查,均未见息肉复发。结论采用EMR治疗无蒂和亚蒂息肉安全、有效。

Endoscopic Mucosal Resection for Non-or Sub-pedicle Gastrointestinal Tract Polyps

Objective To investigated the efficacy and safety of endoscopic mucosal resection （EMR） for non- or sub-pedicle polyps in the gastrointestinal tract. Methods From June 2010 to April 2012, totally 85 patients with gastric polyps （88 lesions） and 62 patients with colorectal polyps （113 lesions） were enrolled into this study. The diameter of the polyps was less than 1.0 cm in 95 lesions, between 1.0 and 2.0 cm in 101 lesions, and between 2.0 to 3.5 cm in 5 lesions. Among the lesions, 72 were non-pedicle and the other 129 were sub-pedicle polyps. One of the patients had five lesions. For the lesions less than 2.0 cm in diameter, submucosal injection plus resection was employed, and for those who had non-pedicle gastric polyps larger than 2.0 cm in diameter or gastric polyps smaller than 2.0 cm but was difficult for looping, EMR-C was used. For sub-pedicle gastric polyps larger than 2.0 cm and all the colorectal polyps larger than 2. 0 cm, endoscopic piecemeal mucosal resection （EPMR） was performed. Results Except for one fiat polyps at the pylori, which received EMR-C, and five lesions of sub- or non-pedicle colorectal polyps that were larger than 2.5 cm in diameter, which underwent EPMR, all the other lesions were removed by using submucosal injection plus resection. No massive hemorrhage or perforation occurred during and after the procedures. Postoperative pathological examination showed 69 hyperplastic polyps, 64 tubular adenomas, 47 inflammatory polyps, 10 tubular villous adenomas, 5 villous adenomas, 2 serrated adenomas, 2 adenoma with high-grade intraepithelial neoplasia （2 cases） , and 2 adenoma with localized cancer （2 cases）. In the two patients with adenoma of high-grade intraepithelial neoplasia, resection of the involved intestinal segment was made in one （ postoperative pathological examination showed no residual tumor tissues） , and EMR was done in the other, who showed no recurrence in 6 months. Among the two cases of adenoma complicated with localized cancer, one of them received radical resection of the tumor immediately （postoperative pathological examination showed local musical injury in the rectum without residual cancer tissues） , and the other refused any surgical treatment, nor re-examination. Follow-up was achieved in 16 patients with gastric polyps and 10 patients with colorectal polyps in one year, and two patients with colorectal polyps in two years; none of them had recurrence during follow-upperiod. ConcLusion EMR is safe and effective for non- or sub-pedicle polyps in the gastrointestinal tract.