Kudo S, Tamura S, Kashida H, Nakajima T, Kusaka H, Fukuoka T, Hirayama K, Tasaka K, Nakajo K
Division of Gastroenterology, Akita Red Cross Hospital.
Nihon Rinsho. 1996 May;54(5):1298-306.
Protruded polyps can usually be treated with conventional polypectomy technique. Slightly elevated lesions without malignant findings are treated with hot biopsy method if they are small enough (less than 5 mm). In order to treat flat or slightly depressed lesions or slightly elevated lesions larger than 5 mm, endoscopic mucosal resection (EMR) technique has been invented. Cancers confined to the mucosa or those only minimally invading the submucosa can be completely removed with this method. However, if histological analysis of the resected specimen shows that the cancer invades the submucosa massively or permeating the vessels, surgical treatment should be added, because otherwise there would be risk of cancer residue or metastasis. When a lesion is suspected to be a submucosal cancer by endoscopic findings and pit pattern analysis from the beginning, then surgical resection is the treatment of choice. Laterally spreading tumors, especially the homogeneous granular type, are good indication for EMR or endoscopic piecemeal mucosal resection (EPMR). It is important to remove the lesion completely confirming that the resection margin is covered with normal pits.
突出的息肉通常可以用传统的息肉切除术治疗。如果病变较小（小于5mm）且无恶性表现，轻微隆起的病变可采用热活检法治疗。为了治疗扁平或轻度凹陷的病变或大于5mm的轻微隆起病变，发明了内镜黏膜切除术（EMR）技术。局限于黏膜或仅轻微侵犯黏膜下层的癌症可以用这种方法完全切除。然而，如果切除标本的组织学分析显示癌症大量侵犯黏膜下层或侵犯血管，则应加行手术治疗，否则会有癌症残留或转移的风险。当通过内镜检查结果和凹陷模式分析从一开始就怀疑病变为黏膜下癌时，手术切除是首选的治疗方法。侧向扩散性肿瘤，尤其是均匀颗粒型，是EMR或内镜分片黏膜切除术（EPMR）的良好适应证。在确认切除边缘覆盖正常凹陷的情况下完全切除病变很重要。
