Bergmann U, Beger H G
Department of General Surgery, University Clinic Ulm, Ulm, Germany.
Surg Endosc. 2003 Mar;17(3):475-9. doi: 10.1007/s00464-002-8931-6. Epub 2002 Nov 6.
Endoscopic mucosal resection (EMR) techniques were evaluated in the treatment of flat and sessile colorectal neoplasm.
Fifty-seven patients (32 female, 25 male) with non-polypoid colorectal lesions (n = 71, size >or= 10 mm) were included in the study. Tumor location, shape, size, and depth (in malignant lesions) were determined by endoscopy and endoscopic ultrasound. EMR was performed using snare resection, endoscopic aspiration mucosectomy, or EMR using a cap-fitted endoscope.
Lesion size ranged from 10 to 50 mm. Complete resection was achieved in 59 of 61 benign and 6 of 8 malignant tumors. Thirty-five tumors were excised in one segment and 34 tumors in piecemeal technique. Pathological examination of neoplasm treated by EMR showed adenoma in 61 and early-stage carcinoma in 8 cases. Because of the non-lifting sign, 2 of 71 tumors were not treated endoscopically and referred to surgical resection revealing a T2 adenocarcinoma in both cases. Resection was incomplete in 2 of 61 adenomas with histological positive resection margin. Complications occurred in 2 patients, with 1 bleeding treated endoscopically and 1 perforation treated by surgery. Local recurrence was observed in 2 of 59 completely resected adenomas and in none of 6 early-stage carcinomas during a mean follow-up of 18 months (range 6 to 30 months).
Advanced non-polypoid colorectal adenomas and early-stage carcinomas can be safely and effectively resected by endoscopic mucosal resection.
评估内镜黏膜切除术（EMR）技术在治疗扁平型和广基型结直肠肿瘤中的应用。
本研究纳入了57例患者（32例女性，25例男性），他们患有非息肉样结直肠病变（共71处病变，大小≥10 mm）。通过内镜检查和内镜超声确定肿瘤的位置、形状、大小以及（恶性病变的）深度。采用圈套器切除术、内镜下黏膜吸引切除术或带帽内镜EMR进行EMR操作。
病变大小在10至50 mm之间。61处良性肿瘤中的59处以及8处恶性肿瘤中的6处实现了完整切除。35处肿瘤通过一次性切除，34处肿瘤采用分片切除技术。经EMR治疗的肿瘤病理检查显示，61例为腺瘤，8例为早期癌。由于出现非抬举征，71处肿瘤中的2处未进行内镜治疗，转而接受手术切除，结果发现这两例均为T2期腺癌。61例腺瘤中有2例切除不完全，组织学切缘阳性。2例患者出现并发症，1例出血通过内镜治疗，1例穿孔通过手术治疗。在平均18个月（范围6至30个月）的随访中，59例完全切除的腺瘤中有2例出现局部复发，6例早期癌均未出现局部复发。
通过内镜黏膜切除术可安全有效地切除进展期非息肉样结直肠腺瘤和早期癌。
