内镜下高频电切除大肠巨大息肉40例体会

目的探讨内镜下电切对大肠巨大息肉的治疗价值．方法回顾性总结2004年1月至2006年12月电子结肠镜下电切除大肠巨大息肉40例资料．结果40例大肠巨大息肉直径2～5cm，直肠13例，乙状结肠14例，降结肠9例，横结肠4例；均为单发，对有蒂的18例及亚蒂的6例直接用电圈套器切除，其余16例广基息肉分别行粘膜切除术和粘膜分块切除术．该40例巨大息肉切除顺利，无出血及穿孔等并发症．术后病理结果为40例均为腺瘤性息肉，其中管状腺瘤26例，绒毛状腺瘤6例，绒毛管状腺瘤8例．40例中有8例为局灶癌变（粘膜内癌），未追加外科手术治疗．所有病例术后随访1～2a均未发现复发．结论内镜下高频电切除可有效安全地治疗大肠巨大息肉．

Endoscopic Excision of Giant Colorectal Polyps by High Frequency Electrotome in 40 Cases

Objective To discuss the therapic value of endoscopic excision of giant colorectal polyps by high frequency electrotome. Methods We retrospectively reviewed endoscopic excision of giant colorectal polyps in 40 cases by high frequency electrotome in our department during January 2004 to December 2006. Results The diameter of 40 cases giant colorectal polyps were 2-5 cm. There were 13 cases in rectum, 14 in sigmoid colon, 9 in descending colon, and 4 in transverse colon. All the cases were single, 18 pedunculated polyps and 6 subpedunculated polyps were excised by endoscopic snare. Another 16 sessile polyps were removed by mucosectomy or piecemeal mucosectomy. All the procedure was successfully without complicating bleeding or perforation. All the pathology after the manipulation was adenomatous polyps, which were 26 canalicular adenoma, 6 villous adenoma, and 8 canalicular-villous adenoma. Among 40 patients, 8 had focal canceration namely were carcinoma in situ, and these patients were not operated. There was no recurrence during the follow up period of 1-2 years. Conclusion Endoscopic resection of giant colorectal polyps by high frequency electrotome is feasible, effective and safe.