Pérez Roldán F, González Carro P, Legaz Huidobro M L, Villafáñez García M C, Soto Fernández S, de Pedro Esteban A, Roncero García-Escribano O, Ruiz Carrillo F
Service of Digestive Diseases, Department of Internal Medicine, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain.
Rev Esp Enferm Dig. 2004 Jan;96(1):36-47. doi: 10.4321/s1130-01082004000100006.
Endoscopic polypectomy is a common technique, but there are discrepancies over which treatment--surgical or endoscopic--to follow in case of polyps of 2 cm or larger.
To analyse the efficacy and complications of colonoscopic polypectomy of large colorectal polyps.
147 polypectomies were performed on 142 patients over an eight-year period. The technique used was that of submucosal adrenaline 1:10000 or saline injection at the base of the polyp, followed by resection of the polyp using a diathermic snare in the smallest number of fragments. Remnant adenomatous tissue was fulgurated with an argon plasma coagulator. Lately, prophylactic hemoclips have been used for thick-pedicle polyps. Complete removal was defined as when a polyp was completely resected in one or more polypectomy sessions. Polypectomy failure was defined as when a polyp could not be completely resected or contained an invasive carcinoma.
The mean patient age was 67.9 years (range, 4-90 years), with 68 men and 79 women. There were 74 sessile polyps, and the most common location was the sigmoid colon. The most frequent histology was tubulovillous. Most of the polyps (96.6%), were resected and cured. This was not achieved in four cases of invasive carcinoma, and a villous polyp of the cecum. All pedunculated polyps were resected in one session, whereas the average number of colonoscopies for sessile polyps was 1.35 +/- 0.6 (range, 1-4). The polypectomy was curative in all of the in situ carcinomata except one. As for complications, 2 colonic perforations (requiring surgery) and 8 hemorrhages appeared, which were controlled via endoscopy. There was no associated mortality.
Endoscopic polypectomy of large polyps (> or =2 cm) is a safe, effective treatment, though it is not free from complications. Complete resection is achieved in a high percentage, and there are few relapses. It should be considered a technique of choice for this type of polyp, except in cases of invasive carcinoma.
内镜下息肉切除术是一种常用技术，但对于直径2厘米及以上的息肉，后续应采用手术治疗还是内镜治疗存在分歧。
分析大肠大息肉结肠镜息肉切除术的疗效及并发症。
在八年期间，对142例患者实施了147例息肉切除术。采用的技术是在息肉基底部注射1:10000肾上腺素或生理盐水进行黏膜下注射，然后用高频电圈套器将息肉切除成最少的碎片。残留的腺瘤组织用氩气刀凝固。最近，对于粗蒂息肉使用了预防性止血夹。完全切除定义为在一次或多次息肉切除术中息肉被完全切除。息肉切除失败定义为息肉无法完全切除或包含浸润性癌。
患者平均年龄为67.9岁（范围4 - 90岁），男性68例，女性79例。有74例无蒂息肉，最常见的部位是乙状结肠。最常见的组织学类型是管状绒毛状。大多数息肉（96.6%）被切除并治愈。4例浸润性癌和1例盲肠绒毛状息肉未达到此效果。所有有蒂息肉均在一次手术中切除，而无蒂息肉的平均结肠镜检查次数为1.35±0.6（范围1 - 4）。除1例原位癌外，所有原位癌的息肉切除术均治愈。至于并发症，出现了2例结肠穿孔（需手术）和8例出血，通过内镜检查得到控制。无相关死亡病例。
大肠大息肉（≥2厘米）的内镜息肉切除术是一种安全、有效的治疗方法，尽管并非没有并发症。高比例实现了完全切除，复发很少。除浸润性癌外，应将其视为这类息肉的首选治疗技术。
