圈套器预切除联合内镜黏膜下剥离术治疗结直肠巨大腺瘤性息肉的初步体会

Preliminary study of snare precutting combined with endoscopic submucosal dissection in the treatment of colorectal giant adenomatous polyps

摘要:

目的 探讨圈套器预切除联合内镜黏膜下剥离术（ESD）治疗巴黎分型0 ~Ⅰs且直径≥5.0 cm的结直肠巨大腺瘤性息肉的有效性及安全性。方法 回顾性分析2022年11月－2024年10月在该院行圈套器预切除联合ESD治疗结直肠巨大腺瘤性息肉的9例患者的临床资料。观察指标包括：完全切除率、手术时间、住院时间和不良事件发生率。结果 所有患者均顺利完成圈套器预切除联合ESD治疗，完全切除率为100.0%（9/9），手术时间为68（56，77）min，术后病理均证实为管状绒毛状腺瘤，伴腺上皮中-重度异型增生，部分合并黏膜内癌，切缘均阴性。术后2 d即可开放饮食，住院时间为6（5，7）d。术中及全程随访无穿孔、出血等手术相关不良事件，随访期未见病灶残留、复发及远处转移。结论 圈套器预切除联合ESD可充分暴露术野，降低操作难度，对巴黎分型0 ~Ⅰs且直径≥5.0 cm的结直肠巨大腺瘤性息肉切除彻底，安全性高，其是临床处理此类难治性癌前病变及早期黏膜内癌的创新内镜方案，具备推广应用价值。

Abstract:

Objective To investigate the efficacy and safety of snare precutting combined with endoscopic submucosal dissection (ESD) in the treatment of Paris classification type 0~Ⅰs colorectal giant adenomatous polyps with a diameter ≥5.0 cm.Methods Data from patients with colorectal giant adenomatous polyps who underwent the combined treatment from November 2022 to October 2024 were retrospectively collected and analyzed. The complete resection rate, operation time, hospital stay, and incidence of adverse events of this combined procedure were statistically analyzed.Results All patients successfully completed the combined treatment. The complete resection rate was 100.0% (9/9), and the operation time was 68 (56, 77) min. Postoperative pathology confirmed all lesions to be tubovillous adenomas, accompanied by moderate to severe dysplasia of the glandular epithelium, and some cases were complicated with intramucosal carcinoma with all margins negative. A normal diet could be resumed 2 days postoperatively, and the hospital stay was 6 (5, 7) days. No surgery-related adverse events such as perforation or bleeding occurred intraoperatively or during the entire follow-up period. No residual lesions, recurrence or distant metastasis were observed throughout follow-up.Conclusion The combined treatment can adequately expose the operative field and reduce technical difficulty. For Paris classification type 0~Ⅰs colorectal giant adenomatous polyps with a diameter ≥5.0 cm, this technique achieves complete resection with high safety. It represents an innovative endoscopic strategy for the clinical management of such refractory precancerous lesions and early intramucosal earcinoma and warrants widespread clinical promotion and application.