Kaltenbach Tonya, Soetikno Roy
Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, GI-111, Palo Alto, CA 94304, USA.
Gastrointest Endosc Clin N Am. 2010 Jul;20(3):503-14. doi: 10.1016/j.giec.2010.03.009. Epub 2010 Jun 8.
Endoscopic mucosal resection (EMR) is preferred to standard polypectomy for the resection of non-polypoid lesions because these lesions can be technically difficult to capture with a snare; furthermore, without submucosal injection the underlying muscularis propria may be excessively coagulated or even inadvertently resected. Because the resection plane of EMR is in the middle or deeper part of the submucosa, EMR allows the precise depth of the lesion to be evaluated. Although the majority of non-polypoid lesions are adenomatous, non-polypoid colorectal neoplasm has a high association with advanced pathology, irrespective of size. Using EMR, a complete pathologic specimen is obtained, the risk of lymph node metastasis can be accurately assessed based on the depth of invasion, and patients can be suitably managed. Used according to its indications, EMR provides curative resection, and obviates the higher morbidity, mortality, and cost associated with surgical treatment.
对于非息肉样病变的切除，内镜黏膜切除术（EMR）优于标准息肉切除术，因为这些病变在技术上难以用圈套器捕获；此外，若不进行黏膜下注射，固有肌层可能会过度凝固甚至被意外切除。由于EMR的切除平面在黏膜下层的中部或更深部位，EMR可对病变的精确深度进行评估。尽管大多数非息肉样病变是腺瘤性的，但无论大小，非息肉样结直肠肿瘤与高级别病理高度相关。使用EMR可获得完整的病理标本，根据浸润深度可准确评估淋巴结转移风险，并能对患者进行适当的治疗。按照其适应证使用，EMR可实现根治性切除，避免了与手术治疗相关的更高发病率、死亡率和成本。
