Spychalski Michał, Buczyński Jarosław, Cywiński Jarosław, Dziki Łukasz, Langner Ewa, Sygut Andrzej, Trzciński Radzisław, Dziki Adam
General and Colorectal Surgery Departament, Medical University in Łódź.
Pol Przegl Chir. 2011 Oct;83(10):531-6. doi: 10.2478/v10035-011-0084-7.
Endoscopic polypectomy of colorectal polyps is a common procedure. However, endoscopic treatment of large polyps (those with a diameter exceeding 2 cm) remains questionable. There is a serious risk of colorectal carcinoma presence inside these lesions, which eventually would require surgical intervention. Apart from this fact endoscopic polypectomy of large polyps is connected with substantial risk of complications, such as perforation and bleeding. Many patients with large colorectal polyps are qualified for surgical intervention. THE AIM OF THE STUDY was to determine the efficacy and safety of polypectomy of large colorectal polyps.
The study presented results of endoscopic treatment in case of patients with large colorectal polyps at the Department of General and Colorectal Surgery, Medical University in Łódź. Patients were admitted to the hospital during the period between January, 2008 and January, 2010. The following parameters were analysed: location of polyps, percentage of high grade dysplasia, complete excision rate, and complications connected with polypectomy procedures.
During the analyzed period of time 488 endoscopic polypectomies were performed. Forty-three large colorectal polyps were removed (8.8%). Seven (16.3%) of them were classified as flat polyps. Out of 488 removed polyps, 39 were classified as adenomas with high grade dysplasia (7.9%), while 16 were large-exceeding 2 cm (37.2%). Considering the group of large polyps no invasive carcinoma case was detected. The radical excision rate for large pedunculated polyps was obtained in 88.8% (32/36) of cases. In case of flat adenomas the above-mentioned parameter was lower--57.1% (4/7). During polypectomy of large colorectal polyps one perforation was observed during the excision of a flat cecal polyp. In two cases immediate bleeding occurred (2/43). In both cases endoscopic treatment of bleeding proved sufficient.
Endoscopic polypectomy of large pedunculated polyps is a safe and efficient method, which makes it a rationale alternative for surgery. Polypectomy of flat adenomas is connected with a lower radical excision rate and higher risk of perforation.
大肠息肉的内镜下息肉切除术是一种常见的手术。然而，大型息肉（直径超过2厘米）的内镜治疗仍存在疑问。这些病变内部存在结直肠癌的严重风险，最终可能需要手术干预。除此之外，大型息肉的内镜下息肉切除术还存在诸如穿孔和出血等严重并发症风险。许多患有大型大肠息肉的患者适合进行手术干预。本研究的目的是确定大型大肠息肉息肉切除术的疗效和安全性。
本研究展示了罗兹医科大学普通外科和结直肠外科对大型大肠息肉患者进行内镜治疗的结果。患者于2008年1月至2010年1月期间入院。分析了以下参数：息肉位置、高级别异型增生百分比、完整切除率以及与息肉切除术相关的并发症。
在分析期间共进行了488例内镜下息肉切除术。切除了43个大型大肠息肉（8.8%）。其中7个（16.3%）为扁平息肉。在488个切除的息肉中，39个被归类为高级别异型增生腺瘤（7.9%），而16个为大型——超过2厘米（37.2%）。在大型息肉组中未检测到浸润性癌病例。带蒂大型息肉的根治性切除率在88.8%（32/36）的病例中获得。对于扁平腺瘤，上述参数较低——57.1%（4/7）。在大型大肠息肉息肉切除术中，在切除一个扁平盲肠息肉时观察到1例穿孔。2例出现即时出血（2/43）。在这两例中，内镜下止血治疗被证明是充分的。
带蒂大型息肉的内镜下息肉切除术是一种安全有效的方法，使其成为手术的合理替代方案。扁平腺瘤的息肉切除术根治性切除率较低且穿孔风险较高。
