Pisano G, Zonza C, Erdas E, Pomata M, Daniele G M
Sezione di Chirurgia Generale II, Dipartimento di Scienze Chirurgiche e Trapianti d'Organo dell'Università di Cagliari.
Chir Ital. 2001 Jul-Aug;53(4):555-62.
Large colonic villous adenomas are benign neoplasms capable of malignant transformation with a higher frequency than other adenomas. Such transformation often requires surgical therapy after endoscopic resection. The aim of the present study was to establish the indications for surgery in a series of 13 cases of large colonic villous adenomas initially submitted to endoscopic resection. The patients (8 males and 5 females; mean age; 62 years) were observed over the period 1993-2000. All endoscopic resections were performed using the piecemeal technique. In 7 cases there were 2 endoscopic sessions and in one case 3; a single case of post-endoscopic bleeding was treated conservatively. In 5 cases, endoscopic resection was deemed not to be radical and these patients were submitted to surgical resection. Histology on the surgical specimens revealed 2 cases of carcinoma (T1 and T2, respectively), confirmation of colonic villous adenoma in 2 cases and the presence of inflammatory tissue in 1 case. Among the patients treated with endoscopic resection alone one death occurred at two years due to lung and systemic metastases probably due to the malignant adenoma. After a review of the literature and on the basis of their own experience, the authors stress the importance of a combined pathological and endoscopic approach to establish when surgery is required.
大肠绒毛状腺瘤是良性肿瘤，但其恶变频率高于其他腺瘤。这种恶变通常在内镜切除后需要手术治疗。本研究的目的是确定13例最初接受内镜切除的大肠绒毛状腺瘤患者的手术指征。对1993年至2000年期间的患者（8例男性和5例女性；平均年龄62岁）进行了观察。所有内镜切除均采用分块技术。7例患者进行了2次内镜检查，1例进行了3次；1例内镜后出血患者接受了保守治疗。5例患者的内镜切除被认为不彻底，这些患者接受了手术切除。手术标本的组织学检查显示2例癌（分别为T1和T2），2例证实为大肠绒毛状腺瘤，1例为炎性组织。在仅接受内镜切除的患者中，1例患者在两年时因可能由恶性腺瘤导致的肺和全身转移而死亡。在回顾文献并根据自身经验后，作者强调了采用病理和内镜联合方法来确定何时需要手术的重要性。
