Service des Maladies de l'Appareil Digestif, CHU Pontchaillou, Rennes, France.
Colorectal Dis. 2013 Jun;15(6):683-8. doi: 10.1111/codi.12122.
Endoscopic resection is the primary treatment for colorectal adenoma, but in some cases surgery is necessary. The aim of this retrospective study was to define the prevalence and predictive factors for surgery in patients with advanced colorectal adenoma managed in a referral endoscopy centre.
Consecutive patients diagnosed with advanced adenoma (Class 4 in the Vienna classification) during a colonoscopy from 2007 to 2009 in the endoscopy centre of the University Hospital of Rennes were included. Predictive factors of surgery were determined by univariate and multivariate analysis.
Two-hundred and twelve (135 male) patients with a mean age of 65.8 years were included. The reason for colonoscopy was for diagnosis in 63.2%, surveillance in 25.5% and screening in 11.3%. These referred patients amounted to 20.8% of all patients having colonoscopy. Surgery was performed in 13.7% of the 212 patients and in 16 (8.3%) of the 192 patients in whom endoscopic removal was attempted. In the subgroup of 192 patients, univariate analysis revealed that body mass index (P = 0.04), histology (P = 0.002), size (P = 0.03) and macroscopic appearance (P < 0.001) of the polyp were associated with surgery. Multivariate analysis revealed that the macroscopic appearance and histology only were significantly associated with surgery.
Surgery was needed in 13.7% of patients with an advanced adenoma, but in only 8.3% of the subgroup of 192 patients in whom endoscopic removal was attempted. Factors associated with surgery included macroscopic appearance and histology.
内镜下切除术是结直肠腺瘤的主要治疗方法，但在某些情况下需要手术。本回顾性研究旨在确定在转诊内镜中心接受治疗的进展期结直肠腺瘤患者中手术的患病率和预测因素。
纳入 2007 年至 2009 年在雷恩大学医院内镜中心行结肠镜检查诊断为高级别腺瘤（维也纳分类第 4 类）的连续患者。通过单因素和多因素分析确定手术的预测因素。
共纳入 212 例（男 135 例）患者，平均年龄为 65.8 岁。结肠镜检查的原因分别为诊断（63.2%）、监测（25.5%）和筛查（11.3%）。这些转诊患者占所有行结肠镜检查患者的 20.8%。212 例患者中 13.7%行手术，192 例尝试内镜下切除的患者中有 16 例（8.3%）行手术。在 192 例患者的亚组中，单因素分析显示体重指数（P = 0.04）、组织学（P = 0.002）、大小（P = 0.03）和息肉的大体外观（P < 0.001）与手术相关。多因素分析显示，只有大体外观和组织学与手术显著相关。
高级别腺瘤患者中有 13.7%需要手术，但在尝试内镜下切除的 192 例患者亚组中仅有 8.3%需要手术。与手术相关的因素包括大体外观和组织学。
