Dell'Abate P, Iosca A, Galimberti A, Piccolo P, Soliani P, Foggi E
Clinic of General Thoracic and Vascular Surgery, University of Parma, Parma, Italy.
Dis Colon Rectum. 2001 Jan;44(1):112-8. doi: 10.1007/BF02234832.
Colonoscopic polypectomy is the preferred technique to remove the majority of polyps. The authors evaluate feasibility, safety, and the effectiveness of endoscopic treatment of colorectal benign-appearing polyps equal to or larger than 3 cm.
Ninety-seven patients with 104 giant polyps underwent polypectomy within a nine-year period. The majority of these procedures were performed on an outpatient basis, all on unsedated patients. Gross appearance, size, location, histologic characteristics, synchronous lesions, modality, and adequacy of removal of giant polyps were analyzed. The follow-up was achieved in 89 percent of patients during a period ranging from 6 to 96 months (median, 38).
Of the 104 removed polyps, 75 (72 percent) were adenomatous, 2 (2 percent) were hyperplastic, and 27 (26 percent) were malignant polyps. Six patients had more than one giant polyp. Several additional smaller polyps were found in 52 patients and a synchronous cancer in 4. Twenty-one (20 percent) giant polyps were equal to or larger than 4 cm. Forty-nine were pedunculated, 20 were short-stalked, and 35 were sessile. Sixty-one polyps were excised in one piece, and forty-three were excised using a piecemeal technique. Only four complications (3.8 percent) were recorded; all cases were treated endoscopically. Fifty-eight (75 percent) adenomas and eighteen (67 percent) malignant polyps were completely excised. Surgery was performed in 7 of 27 patients (27 percent) with malignant polyps, where there was a doubtful, infiltrated margin or poorly differentiated cancer. Postpolypectomy surveillance permitted the detection and treatment of 25 metachronous or recurrent polyps and a metachronous cancer.
This study shows that polypectomy of giant colorectal polyps, performed by an expert endoscopist, is feasible, effective, and safe, even on an outpatient basis. The authors confirm that malignant polyps with incomplete excision, lymphovascular invasion, and poor differentiation require bowel resection. Postpolypectomy surveillance is useful for all patients who have undergone colonoscopic resection of giant adenomatous or malignant polyps.
结肠镜息肉切除术是切除大多数息肉的首选技术。作者评估了内镜治疗直径等于或大于3 cm的结直肠外观良性息肉的可行性、安全性和有效性。
97例患者的104枚巨大息肉在9年期间接受了息肉切除术。这些手术大多在门诊进行，所有患者均未使用镇静剂。分析了巨大息肉的大体外观、大小、位置、组织学特征、同步病变、手术方式及切除的充分性。89%的患者在6至96个月（中位数为38个月）期间进行了随访。
在切除的104枚息肉中，75枚（72%）为腺瘤性，2枚（2%）为增生性，27枚（26%）为恶性息肉。6例患者有不止一枚巨大息肉。52例患者发现了其他几枚较小的息肉，4例患者发现了同步癌。21枚（20%）巨大息肉直径等于或大于4 cm。49枚有蒂，20枚短蒂，35枚无蒂。61枚息肉完整切除，43枚采用分块切除技术切除。仅记录到4例并发症（3.8%）；所有病例均在内镜下治疗。58枚（75%）腺瘤和18枚（67%）恶性息肉被完全切除。27例恶性息肉患者中有7例（27%）因切缘可疑、浸润或低分化癌而接受了手术。息肉切除术后的监测发现并治疗了25枚异时性或复发性息肉及1例异时性癌。
本研究表明，由专业内镜医师进行的结直肠巨大息肉切除术是可行、有效且安全的，甚至在门诊即可进行。作者证实，切除不完全、有淋巴管侵犯及低分化的恶性息肉需要行肠切除术。息肉切除术后的监测对所有接受结肠镜切除巨大腺瘤性或恶性息肉的患者均有用。
