Wilhelm Dirk, von Delius Stefan, Weber Lars, Meining Alexander, Schneider Armin, Friess Helmut, Schmid Roland M, Frimberger Eckart, Feussner Hubertus
Working Group for Minimally Invasive Therapy and Intervention, Technische Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany.
Surg Endosc. 2009 Apr;23(4):688-93. doi: 10.1007/s00464-008-0282-5. Epub 2009 Jan 24.
Large, colorectal polyps or those that are difficult to access may be unamenable to conventional snare polypectomy and may require surgical resection. This study was designed to evaluate the resection of such lesions by the use of combined laparoscopic-endoscopic resections (CLER).
Patients who had received CLER for colorectal polyps between January 1997 and December 2006 were identified from a prospectively maintained database. Patients with biopsies consistent with invasive cancer were excluded from the combined approach. Baseline characteristics, surgical, pathological, postoperative, and follow-up data of patients and lesions were reviewed.
A total of 146 consecutive patients underwent CLER for 154 lesions, and 120 (82%) patients underwent local excision (i.e., laparoscopy-assisted endoscopic resection, endoscopy-assisted wedge resection, and endoscopy-assisted transluminal resection). Twenty-six (18%) patients received endoscopy-assisted segmental colon resection. Conversion rate was 5% and intraoperative complications occurred in two patients (1%). Major postoperative complications occurred in five patients (3%), necessitating surgical reintervention in four of them. Follow-up colonoscopy revealed metachronous adenomas in 33 patients, of which 8 patients showed macroscopic or microscopic characteristics of advanced lesions. One patient, who had been converted to open resection because of incomplete laparoscopic resection of an adenoma, developed relapse of the initial adenoma and was successfully treated with repeat CLER accounting for a local recurrence rate of 0.9%.
Combined laparoscopic-endoscopic resection is an efficient, safe, and minimally invasive alternative to open resection for selected patients with difficult polyps, but it should be restricted to benign disease.
大型结直肠息肉或难以触及的息肉可能无法进行传统圈套息肉切除术，可能需要手术切除。本研究旨在评估通过联合腹腔镜-内镜切除术（CLER）切除此类病变的效果。
从一个前瞻性维护的数据库中识别出1997年1月至2006年12月期间接受CLER治疗结直肠息肉的患者。活检结果与浸润性癌一致的患者被排除在联合治疗方法之外。回顾了患者和病变的基线特征、手术、病理、术后及随访数据。
共有146例连续患者因154个病变接受了CLER，其中120例（82%）患者接受了局部切除（即腹腔镜辅助内镜切除、内镜辅助楔形切除和内镜辅助腔内切除）。26例（18%）患者接受了内镜辅助节段性结肠切除。转换率为5%，两名患者（1%）发生术中并发症。5例患者（3%）发生主要术后并发症，其中4例需要再次手术干预。随访结肠镜检查发现33例患者有异时性腺瘤，其中8例显示有高级别病变的宏观或微观特征。1例因腺瘤腹腔镜切除不完全而转为开放切除的患者，初始腺瘤复发，经重复CLER成功治疗，局部复发率为0.9%。
对于选定的患有复杂息肉的患者，联合腹腔镜-内镜切除术是一种有效、安全且微创的替代开放切除的方法，但应仅限于良性疾病。
