内镜热损伤术后息肉样结节瘢痕的病理性质及处理策略探讨

Discussion on pathogenesis and processing strategy of polypoid nodule scar after endoscopic heat injury treatment

摘要:

目的 总结内镜热损伤治疗术后息肉样结节瘢痕（PNS）的病理性质和发生机制，并探讨处理策略。方法 选择2015年3月－2019年3月于该科行内镜氩等离子体凝固术（APC）、内镜下黏膜切除术（EMR）和内镜黏膜下剥离术（ESD）治疗胃黏膜增生性病变的患者，回顾性分析发生PNS的7例患者的诊治及随访资料。同时，在中国知网（CNKI）、万方数据知识服务平台、中国生物医学数据库等中国数据库以及PubMed、Science Direct Online （SDOL）等国外数据库中检索相关文献，总结PNS的病理特征及随访结果。结果 临床资料：该科内镜治疗黏膜增生性病变后PNS发生率为1.21%（7/579），男5例，女2例，病变均位于胃窦。4例追加了ESD，术后标本切缘病理阴性，但随访复查中，手术瘢痕处再次发现息肉样结节。另外3例PNS未追加治疗，其中1例术后3个月发现息肉样结节，未作处理，术后6个月复查结节消失。文献检索结果：中文数据库无相关文献，在Science Direct Online（SDOL）和PubMed中检索到2篇相关文献，1篇为ESD术后发生PNS的个案报道，另一篇为多中心研究，前一篇文献资料包含在后一篇文献中。多中心研究文献显示：ESD术后PNS总体发病率为1.23%，各中心PNS发病率为0.15%～11.40%，所有发生PNS的患者原发病变均位于胃远端，长期随访无恶性肿瘤复发，17.86%的病例PNS于平均随访18个月后消失。结论 只要原发病变根治性切除，PNS在组织学上仅显示为再生和增生性组织，应被视为良性病变，除定期复查外，不需任何干预，即使内镜下切除，仍有可能复发。

Abstract:

Objective To summarize the pathological properties and pathogenetic mechanism of abnormal polypoid nodule scar (PNS) after endoscopic thermoprobe therapy, and explore its clinical processing strategy.Methods We reviewed the diagnosis, treatment and follow-up of 7 patients with PNS who underwent endoscopic argon plasma coagulation (APC), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) for gastric mucosal hyperplastic lesions from March 2015 to March 2019. At the same time, relevant literatures were searched and reviewed in Chinese databases such as CNKI, Wanfang Data Knowledge Service Platform and China Biomedical Database, as well as foreign databases such as PubMed and Science Direct Online (SDOL) to summarize the pathological characteristics and follow-up results of PNS.Results Clinical data: The incidence of PNS after endoscopic heat injury treatment of mucosal hyperplastic lesions in this department was 1.21% (7/579), five of them were male and two were female; Postoperative polypoid nodular scar was found in all cases, which were located in the gastric antrum. Among of them, 4 cases received additional ESD surgery, and the postoperative incision margin pathology was negative, but in the postoperative follow-up review, polypoid nodules were found again in the surgical scar. The other three PNS patients had no additional treatment. In one of them, polypoid nodules were found untreated at 3 months after surgery, and the nodules disappeared at 6 months after surgery. Literature retrieval results: There is no relevant literature in the Chinese database. Two relevant literatures were retrieved from Science Direct Online (SDOL) and PubMed. One paper was a case report of PNS after ESD.The other paper was a multi-center study of PNS after ESD operation, and the information from the previous literature was included in the later literature. According to the review of multi-center studies, the overall incidence of PNS after ESD was 1.23%, and the incidence of PNS varied from 0.15% to 11.40% in each center. The primary tumor lesions of all patients with PNS were located in the distal part of the stomach. Long-term follow-up showed no recurrence of malignant tumors, and PNS disappeared in 17.86% of the cases after a mean follow-up of 18 months.Conclusion As long as the primary lesion is radical resection and the PNS is histologically only showing regenerative and proliferative tissue, it should be regarded as benign lesion. In addition to regular review, any type of intervention may not be required, and recurrence may still occur even if endoscopic resected again .