內鏡下黏膜切除術治療結腸憩室腺瘤的療效分析

背景：當結腸腺瘤累及憩室時，憩室內的炎癥狀態會增加腺瘤性病變的異型增生風險，故結腸憩室腺瘤更易發生惡變，需切除腺瘤以避免結腸癌結局，改善預后。目的：探討內鏡下黏膜切除術（EMR）治療結腸憩室腺瘤的有效性和安全性。方法：連續收集2018年6月—2022年1月于杭州市臨安區第一人民醫院接受EMR治療的14例結腸憩室腺瘤（憩室內部或憩室附近）病例，分析其臨床特征和結局。主要結局指標為并發癥，包括出血、穿孔和電凝綜合征，次要結局指標為整塊切除率、完全切除率和局部復發率。結果：14例結腸憩室腺瘤患者中，A型（憩室旁型）13例，B型（憩室內型）1例；病灶直徑為（0.76±0.25） cm；手術時間為（19.67±5.33） min；組織學類型以管狀腺瘤為主，病理性質以上皮內瘤變多見。1例（7.1%）患者發生遲發性出血，1例（7.1%）發生電凝綜合征，未見穿孔事件。整塊切除率、完全切除率均為100%。術后1年內10例復查結腸鏡，均未發現局部復發。結論：EMR治療結腸憩室腺瘤具有安全、有效的特點，但抗血小板藥服用史和同時累及闌尾孔、憩室的結腸腺瘤患者需警惕術后并發癥。

關鍵詞 內鏡下黏膜切除術； 結腸腺瘤； 憩室； 并發癥； 治療

Efficacy of Endoscopic Mucosal Resection in Treatment of Colonic Diverticulum Adenoma LIU Bin， CHEN Xinglin， QI Qinqin， CAI Yuanyuan， WEI Ke， WANG Zhemin， CHEN Liuyong. Department of Gastroenterology， the First People′s Hospital of Hangzhou Lin′an District， Hangzhou （311300）

Background： When colonic adenoma involves diverticulum， inflammation in the diverticulum will increase the risk of adenomatous dysplasia. Therefore， patients with colonic diverticulum adenoma are at a higher risk of colon cancer， and the adenoma needs to be resected to avoid poor outcome and improve prognosis. Aims： To explore the efficacy and safety of endoscopic mucosal resection （EMR） in treatment of colonic diverticulum adenoma. Methods： Fourteen consecutive cases of colonic adenoma near or involving a diverticulum treated by EMR from Jun. 2018 to Jan. 2022 at the First People′s Hospital of Hangzhou Lin′an District were collected， and their clinical characteristics and outcomes were analyzed. The primary outcome was complications， including bleeding， perforation， and electrocoagulation syndrome， while the secondary outcomes were the en bloc resection rate， complete resection rate and local recurrence rate. Results： Among the 14 patients with colonic diverticulum adenoma， 13 were type A （near a diverticulum） while 1 was type B （involving a diverticulum）. The diameter of the lesion was （0.76±0.25） cm， and the operation time was （19.67±5.33） minutes. The main histological type was tubular adenoma， and the pathological results was intraepithelial neoplasia in most of the cases. Delayed hemorrhage was observed in 1 patient （7.1%）， and electrocoagulation syndrome in 1 patient （7.1%）. No perforation event occurred. The en bloc resection rate and complete resection rate were 100%. Ten patients accepted reexamination of colonoscopy within 1 year after surgery， and no local recurrence was found. Conclusions： EMR is safe and effective for treatment of colonic diverticulum adenoma. However， patients using antiplatelet drugs and adenoma involving both appendiceal orifice and diverticulum should be alert to postoperative complications.

Key words Endoscopic Mucosal Resection; Colonic Adenoma; Diverticulum; Complications; Therapy

結腸憩室是黏膜和部分黏膜下層經腸壁肌層缺損處向外形成的疝[1]，常見于遠端結腸。對于累及結腸憩室的病變，手術治療是標準治療方案[2]，但外科手術因較多并發癥和經濟負擔而限制了其在臨床的廣泛應用。內鏡治療不失為一種潛在選擇，既往有研究證實內鏡黏膜下剝離術（ESD）治療結腸憩室腺瘤具有可行性[2?3]，但內鏡下黏膜切除術（EMR）是否同樣適用目前尚缺乏系統研究的支持。……