Voloyiannis Theodoros, Snyder Michael J, Bailey Randolph R, Pidala Mark
University of Texas Houston, Health Science Center, Colon and Rectal Surgery, Houston, Texas 77090, USA.
Dis Colon Rectum. 2008 Mar;51(3):292-5. doi: 10.1007/s10350-007-9175-2. Epub 2008 Jan 18.
Patients are frequently referred for resection of difficult colon polyps. Before colectomy the experienced surgeon has the option of repeating the colonoscopy to assess the polyp, tattoo the site, and potentially remove the polyp. The purpose of this study was to review our results with this approach.
All new patients referred during a five-year period to an 11-physician colon and rectal surgical group with the diagnosis of colon polyp (CPT 211.3) that was not previously removed were retrospectively reviewed. Patients with rectal polyps, inflammatory bowel disease, previous cancer, or familial adenomatous polyposis were excluded. Patient demographics, details of the polyps, success of polypectomy, reasons for surgical resection, pathology, and complications were analyzed.
The study population consisted of 252 patients with a mean age of 65 years. Eighty patients underwent resection upon referral without a repeat colonoscopy. Upon resection, invasive cancers were found in 13 cases. A total of 172 patients underwent at least one repeat colonoscopy by the colorectal surgeon. Of this group, 101 patients had successful polypectomy, thus avoiding major colectomy. The remaining 71 patients had a subsequent colon resection after at least one repeat colonoscopy. In 26 cases the polyp site was tattooed for later localization. There were nine postpolypectomy hemorrhages treated nonoperatively and two perforations.
Repeat colonoscopy by an experienced surgeon leads to complete removal and avoidance of major colectomy in 58 percent of these cases. Patients with large difficult polyps referred for resection should be considered for repeat colonoscopy before surgery.
患者常因难以切除的结肠息肉而前来就诊。在进行结肠切除术之前，经验丰富的外科医生可以选择再次进行结肠镜检查，以评估息肉情况、标记息肉部位，并有可能切除息肉。本研究的目的是回顾我们采用这种方法的结果。
回顾性分析在五年期间转诊至一个由11名医生组成的结肠直肠外科团队、诊断为结肠息肉（CPT 211.3）且此前未切除的所有新患者。排除患有直肠息肉、炎症性肠病、既往癌症或家族性腺瘤性息肉病的患者。分析患者的人口统计学资料、息肉细节、息肉切除术的成功率、手术切除的原因、病理情况及并发症。
研究人群包括252例患者，平均年龄65岁。80例患者在转诊时未进行再次结肠镜检查即接受了切除手术。切除术中发现13例浸润性癌。共有172例患者接受了结直肠外科医生至少一次的再次结肠镜检查。在这组患者中，101例患者息肉切除成功，从而避免了大的结肠切除术。其余71例患者在至少一次再次结肠镜检查后接受了结肠切除术。26例患者对息肉部位进行了标记以便后续定位。有9例息肉切除术后出血经非手术治疗，2例发生穿孔。
经验丰富的外科医生进行再次结肠镜检查可使58%的此类病例实现息肉完全切除并避免大的结肠切除术。对于因难以切除的大息肉而转诊进行切除手术的患者，术前应考虑再次进行结肠镜检查。
