General Surgery Department, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, 100144, China.
Adv Ther. 2021 May;38(5):2662-2672. doi: 10.1007/s12325-021-01635-8. Epub 2021 Apr 17.
The study aimed to investigate the application of core needle biopsy through the trocar hole during surgery on endoscopically unresectable giant colon polyps.
The clinical data of 51 patients with endoscopically unresectable giant colon polyps from May 2016 to May 2020 were retrospectively analyzed. The primary observational outcomes were two comparative analyses of pathologic results, using the kappa index: comparison of the pathologic results from the preoperative colonoscopy and the postoperative pathologic results and comparison of the intraoperative pathologic results from core needle biopsy of the intestinal wall and the postoperative pathologic results. The secondary observational outcomes were duration of needle biopsy, operation duration, volume of intraoperative hemorrhage, rate of postoperative wound infection, rate of abdominal cavity infection, length of stay, and number and positivity of lymph node dissections after laparoscopic radical resection of colon cancer.
Poor consistency was found between the preoperative (colonoscopy) and postoperative pathologic results, with kappa = 0.222 (i.e., kappa < 0.4), P < 0.05. However, good consistency was found between the intraoperative (core needle biopsy) and postoperative pathologic results, with kappa = 0.923 (i.e., kappa ≥ 0.75), P < 0.05. The postoperative pathologic results were as follows: 7 cases of adenomatous polyps of the colon, 12 cases of low-grade intraepithelial neoplasia, 12 cases of high-grade intraepithelial neoplasia, and 25 cases of invasive colon cancer. There was no incision infection, no abdominal cavity infection or formation of an abdominal abscess, no anastomotic leakage, and no death for any of the 51 patients. Postoperative complications occurred in two cases (3.92%).
Biopsy through the trocar hole during laparoscopic surgery produced highly accurate pathologic results and was a fast, safe, and effective diagnostic method. Pathologic results from intraoperative biopsy could accurately determine the nature of colon polyps and provide a basis for choosing an appropriate surgical scheme.
本研究旨在探讨在无法经内镜切除的巨大结肠息肉患者的手术中通过套管针孔进行空心针活检的应用。
回顾性分析 2016 年 5 月至 2020 年 5 月期间 51 例无法经内镜切除的巨大结肠息肉患者的临床资料。主要观察指标为两种病理结果的对比分析，使用kappa 指数：术前结肠镜检查与术后病理结果的对比分析，以及肠壁空心针活检的术中病理结果与术后病理结果的对比分析。次要观察指标为针活检持续时间、手术持续时间、术中出血量、术后伤口感染率、腹腔感染率、住院时间、腹腔镜结肠癌根治术后淋巴结清扫的数量和阳性率。
术前（结肠镜检查）与术后病理结果一致性较差，kappa 值为 0.222（即 kappa 值<0.4），P<0.05。然而，术中（空心针活检）与术后病理结果一致性较好，kappa 值为 0.923（即 kappa 值≥0.75），P<0.05。术后病理结果如下：结肠腺瘤性息肉 7 例，低级别上皮内瘤变 12 例，高级别上皮内瘤变 12 例，浸润性结肠癌 25 例。51 例患者均无切口感染、腹腔感染或脓肿形成、吻合口漏、死亡。术后发生并发症 2 例（3.92%）。
腹腔镜手术中经套管针孔活检获得了高度准确的病理结果，是一种快速、安全、有效的诊断方法。术中活检的病理结果可准确判断结肠息肉的性质，为选择合适的手术方案提供依据。
