结直肠良、恶性息肉微创治疗的临床研究

目的探讨结肠镜、腹腔镜及双镜联合治疗结直肠息肉的适应证和疗效。方法2004年1月～2006年12月，全结肠镜愉奄发现直径〉1cm的结直肠息肉共378例。结肠镜圈套器摘除319例，结肠镜黏膜切除术（endoscopic mucosal resection，EMR）11例，腹腔镜辅助结肠镜下治疗7例，结肠镜辅助腹腔镜楔形切除术6例，结肠镜辅助腹腔镜肠段切除术3例，腹腔镜结直肠癌根治术32例。结果腹腔镜辅助结肠镜治疗组与结肠镜辅助腹腔镜局部切除术组均未出现一例并发症，结肠镜圈套器摘除组中1．6％（5／319）出现并发症。结肠镜组肿瘤残留11例，追加腹腔镜结直肠癌根治术8例。随访中，EMR术1例肿瘤残留，追加腹腔镜结直肠癌根治术。结肠镜辅助腹腔镜楔形切除术中2例为浸润性结直肠癌，追加腹腔镜结直肠癌根治术。结论大部分结直肠良性息肉可以通过单纯结肠镜的方法得到治疗；双镜联合的治疗方式对于结肠镜治疗困难的结直肠息肉是安全、可行的治疗方法。

Minimally Invasive Treatments for Benign and Malignant Colorectal Polyps

Objective To discuss the indications and therapeutic efficacy of endoscopy,laparoscopy,and combination of the both in the treatment of colorectal polyps.Methods From January 2004 to December 2006,totally 378 patients with colorectal polyps(>1 cm) were treated in our department,319 of them underwent simple endoscopic polypectomy,11 received endoscopic mucosal resection(EMR),7 were treated by laparoscopy-assisted endoscopic polypectomy,6 underwent endoscopy-assisted laparoscopic wedge resection,3 underwent endoscopy-assisted laparoscopic segment resection,and 32 received laparoscopic radical resection.Results No complications occurred in the laparoscopy-assisted endoscopic polypectomy and endoscopy-assisted laparoscopic local resection groups,while the morbidity in simple endoscopic group was 1.6%(5/319).Residual tumor was found in 11 patients of the endoscopic therapy group and 1 of the EMR group.Laparoscopic radical colorectal resection was performed on 9 of them(8 of the endoscopic group,and 1 in the EMR group).In the patients who received endoscopy-assisted laparoscopic wedge resection,2 were confirmed as having invasive colorectal carcinoma,and thus underwent laparoscopic radical colorectal resection immediately.Conclusions Most of the benign or noninvasive malignant colorectal polyps can be managed simply by endoscopy.Laparoscopy combined with endoscopy is feasible and safe for the polyps that can not be treated by endoscopy only.