Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada.
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Can J Gastroenterol Hepatol. 2018 Feb 11;2018:7046385. doi: 10.1155/2018/7046385. eCollection 2018.
It is unclear if the availability of new techniques for removal of large colonic polyps has affected the use of segmental colon resection. We sought to evaluate the characteristics of polyps undergoing surgical resection, including involvement of therapeutic gastroenterologists (TG).
484 patients had a colonic resection; 165 (34%) were identified from the pathology database with polyp, adenoma, or mass in the clinical history field; these charts were reviewed.
128 patients (mean age 68 yrs, 72% male) were included. The mean polyp size was 2.9 cm (0.4 cm-12.0 cm). Adenocarcinoma was diagnosed in 50 (39.1%). 97 (75.8%) patients had a polyp that was felt to be unresectable by EMR, and 31 (24.2%) underwent successful EMR followed by surgery for adenocarcinoma ( = 29). The indication for surgery in those with unresectable polyps was variable and was not clearly documented in 51 (52.6%); only 17 of these patients (17.5%) had a TG involved.
A high proportion of polyps managed by segmental resection did not contain adenocarcinoma. This data suggests that even in a tertiary care center where advanced endoscopic techniques are easily available, they are not always utilized. Educational endeavors to ensure that ideal pathways of intervention are utilized require implementation.
目前尚不清楚是否有新的技术可以去除大的结肠息肉，这是否会影响节段性结肠切除术的应用。我们试图评估接受手术切除的息肉的特征，包括治疗性胃肠病学家（TG）的参与。
484 名患者接受了结肠切除术；从病理学数据库中确定了 165 名（34%）患者的临床病史字段中有息肉、腺瘤或肿块；对这些图表进行了审查。
纳入了 128 名患者（平均年龄 68 岁，72%为男性）。平均息肉大小为 2.9cm（0.4cm-12.0cm）。诊断出腺癌 50 例（39.1%）。97 例（75.8%）患者的息肉被认为不能通过 EMR 切除，其中 31 例（24.2%）成功进行了 EMR 治疗，随后因腺癌而行手术治疗（=29）。对于无法切除的息肉，手术的指征各不相同，在 51 例（52.6%）中未明确记录；仅有 17 例（17.5%）患者有 TG 参与。
接受节段性切除术治疗的息肉中，很大一部分不含有腺癌。这些数据表明，即使在一个可以轻松获得先进内镜技术的三级医疗中心，这些技术也并非总是被使用。需要实施教育工作，以确保使用理想的干预途径。
