Tamura S, Nakajo K, Yokoyama Y, Ohkawauchi K, Yamada T, Higashidani Y, Miyamoto T, Ueta H, Onishi S
Department of Endoscopy, Kochi Medical School, Kochi, Japan.
Endoscopy. 2004 Apr;36(4):306-12. doi: 10.1055/s-2004-814204.
We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum.
During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9 % (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1 % (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4 %); twice (more than 1 year), 20 (29.9 %); three times (more than 3 years), 21(31.3 %); and four times or more (more than 5 years), 11 (16.4 %).
A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3 %) and five lesions of the lower rectum (5/29, 17.2 %) (P = 0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the pectinate line frequently recurred in the lower rectum, at a rate of 80 % (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four.
For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.
我们开展这项回顾性研究，以评估直肠侧向发育型肿瘤（LSTs）的内镜治疗频率及预后。比较了直肠下段病变与上段病变的复发率。
在1989年7月至2002年6月期间，共检测出1237例直肠肿瘤。LSTs占所有直肠肿瘤的6.9%（85/1237）。在1237例直肠肿瘤中，共检测出224例直肠下段肿瘤。LSTs占所有直肠下段肿瘤的16.1%（36/224）。对85例LST病变中的67例进行了内镜黏膜切除术（EMR）后的预后评估。LSTs已切除的患者接受内镜随访的频率如下：1次（15例，22.4%）；2次（超过1年），20例（29.9%）；3次（超过3年），21例（31.3%）；4次及以上（超过5年），11例（16.4%）。
对67例接受内镜治疗的LSTs患者进行了内镜随访。我们观察到上段直肠有2处病变复发（2/38，5.3%），下段直肠有5处病变复发（5/29，17.2%）（P = 0.2364）；所有7处病变均为分片切除。水平边缘达齿状线的LSTs在下段直肠的复发率较高，为80%（4/5）。然而，所有患者通过额外的内镜切除均完全治愈，最多接受了4次治疗。
为早期发现复发并成功进行内镜治愈，首次治疗后的几个月内有必要进一步进行结肠镜检查。
