Aubert A, Meduri B, Fritsch J, Aime F, Baglin A, Barbagelata M
Département d'Endoscopie, C.M.C. Foch, Suresnes, France.
Dis Colon Rectum. 1991 May;34(5):372-7. doi: 10.1007/BF02053686.
The association of endoscopic resection with Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenomas. Eight-five patients were included: 49 with surgical contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five tumors had an axial extension between 1 and 3 cm, and 40 tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total tumor destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients. Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal villous adenomas.
内镜下切除术联合Nd:YAG激光光凝术用于治疗大肠良性绒毛状腺瘤。纳入85例患者：49例有手术禁忌证，35例手术切除风险过高，1例拒绝手术。45个肿瘤的轴向延伸为1至3厘米，40个肿瘤的轴向延伸至少为4厘米。在对残留的扁平病变进行激光光凝之前，采用透热圈套切除术切除大的肿瘤碎片。每15天重复治疗一次，直至肿瘤完全被破坏。在内镜治疗的5例患者的活检标本中检测到癌。2例患者失访。78例患者的治疗结果可进行分析。67例患者治疗成功。直径至少为4厘米的病变患者中，77%的患者肿瘤被完全破坏，较小病变患者中93%的患者肿瘤被完全破坏。肿瘤的轴向延伸是影响治疗结果的主要因素。未发生重大并发症。在平均103周的随访期内，肿瘤被完全破坏的患者中有21%复发。复发风险与初始治疗次数和既往手术治疗有关。看来，在Nd:YAG激光光凝之前进行内镜下切除术是一种安全有效的大肠绒毛状腺瘤破坏方法。
