Lipof T, Bartus C, Sardella W, Johnson K, Vignati P, Cohen J
Department of Surgery, University of Connecticut, Farmington, Connecticut, USA.
Dis Colon Rectum. 2005 May;48(5):1076-80. doi: 10.1007/s10350-004-0908-1.
Patients are commonly referred to surgeons for surgical resection of polyps that cannot be excised colonoscopically. Repeating the colonoscopy may be met with resistance by both the patient and the referring endoscopist. However, there are two distinct benefits. First, if the lesion was not marked, tattooing facilitates laparoscopic resection. Second, and more importantly, many of these polyps can be removed endoscopically by an experienced colorectal surgeon, avoiding unnecessary colon resection. Over a period of five years, we have reviewed preoperative colonoscopy in patients who were referred for surgical treatment of benign polyps.
From January 1999 through September 2003 all patients referred for surgical resection of a benign polyp were consecutively entered into a database by a single group of colorectal surgeons. All patients underwent preoperative colonoscopy on the day before the planned colon resection. Patient charts were reviewed, and demographics were recorded. The referral and preoperative colonoscopy reports and all pathology results were reviewed to record the polyp size, location, histology, and subsequent treatment.
Altogether, 71 patients were included in this study. The average size of the polyps was 24 mm (range, 10-60 mm). The location of the polyp as determined by preoperative colonoscopy differed from the location noted on referral colonoscopy in nine patients (13 percent). Surgery was canceled in 23 patients (32 percent), primarily because of complete polypectomy at preoperative colonoscopy. Of the 48 who underwent surgery, 23 (47 percent) had a colonic tattoo placed, at the discretion of the surgeon. Lesions clearly located in the cecum were not tattooed routinely. Of the 48 patients who underwent surgery, 45 (94 percent) underwent laparoscopic colon resection.
We concluded that patients referred for surgical resection of a polyp should undergo repeat colonoscopy preoperatively, given that in our study one-third of patients were spared unnecessary colectomy. In addition, repeat endoscopy by the operating surgeon offers an opportunity to confirm the location of the lesion and place a colonic tattoo to facilitate laparoscopic resection.
患者常因息肉无法通过结肠镜切除而被转诊至外科医生处进行手术切除。再次进行结肠镜检查可能会遭到患者和转诊内镜医师的抵触。然而，这样做有两个明显的益处。其一，如果病变未被标记，纹身有助于腹腔镜切除。其二，更重要的是，许多此类息肉可由经验丰富的结直肠外科医生通过内镜切除，避免不必要的结肠切除。在五年时间里，我们回顾了因良性息肉接受手术治疗患者的术前结肠镜检查情况。
从1999年1月至2003年9月，一组结直肠外科医生将所有因良性息肉接受手术切除的患者连续录入数据库。所有患者在计划进行结肠切除的前一天接受术前结肠镜检查。查阅患者病历并记录人口统计学数据。查阅转诊和术前结肠镜检查报告以及所有病理结果，以记录息肉大小、位置、组织学类型及后续治疗情况。
本研究共纳入71例患者。息肉平均大小为24毫米（范围为10 - 60毫米）。术前结肠镜检查确定的息肉位置与转诊结肠镜检查记录的位置在9例患者（13%）中存在差异。23例患者（32%）的手术被取消，主要原因是术前结肠镜检查时已完全切除息肉。在接受手术的48例患者中，23例（47%）由外科医生酌情进行了结肠纹身。明确位于盲肠的病变通常不进行纹身。在接受手术的48例患者中，45例（94%）接受了腹腔镜结肠切除术。
我们得出结论，因息肉接受手术切除的患者术前应再次进行结肠镜检查，因为在我们的研究中，三分之一的患者避免了不必要的结肠切除术。此外，由手术医生再次进行内镜检查提供了确认病变位置并进行结肠纹身以方便腹腔镜切除的机会。
