In the last years,an increasing interest has been raised on non-polypoid colorectal tumors(NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally,called laterally spreading tumo...In the last years,an increasing interest has been raised on non-polypoid colorectal tumors(NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally,called laterally spreading tumors(LST).LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection.According to the Paris classification,NPTs are distinguished in slightly elevated(0-Ⅱa,less than 2.5 mm),flat(0-Ⅱb) or slightly depressed(0-Ⅱc).NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions,cell proliferation growth progresses in depth in the colonic wall,thus leading to an increased risk of submucosal invasion(SMI) even for smaller neoplasms.NPTs may be frequently missed by inexperienced endoscopists,thus a careful training and precise assessment of all suspected mucosal areas should be performed.Chromoendoscopy or,if possible,narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs,and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and,therefore,to guide the therapeutic decision.Lesions suitable to endoscopic resection are those confined to the mucosa(or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible.Endoscopic mucosal resection(EMR,piecemeal for LSTs > 20 mm,en bloc for smaller neoplasms) remains the first-line therapy for NPTs,whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR.After piecemeal EMR,follow-up colonoscopy should be performed at 3 mo to assess resection completeness.In case of en bloc resection,surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions展开更多
目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围...目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。展开更多
文摘In the last years,an increasing interest has been raised on non-polypoid colorectal tumors(NPT) and in particular on large flat neoplastic lesions beyond 10 mm tending to grow laterally,called laterally spreading tumors(LST).LSTs and large sessile polyps have a greater frequency of high-grade dysplasia and local invasiveness as compared to pedunculated lesions of the same size and usually represent a technical challenge for the endoscopist in terms of either diagnosis and resection.According to the Paris classification,NPTs are distinguished in slightly elevated(0-Ⅱa,less than 2.5 mm),flat(0-Ⅱb) or slightly depressed(0-Ⅱc).NPTs are usually flat or slightly elevated and tend to spread laterally while in case of depressed lesions,cell proliferation growth progresses in depth in the colonic wall,thus leading to an increased risk of submucosal invasion(SMI) even for smaller neoplasms.NPTs may be frequently missed by inexperienced endoscopists,thus a careful training and precise assessment of all suspected mucosal areas should be performed.Chromoendoscopy or,if possible,narrow-band imaging technique should be considered for the estimation of SMI risk of NPTs,and the characterization of pit pattern and vascular pattern may be useful to predict the risk of SMI and,therefore,to guide the therapeutic decision.Lesions suitable to endoscopic resection are those confined to the mucosa(or superficial layer of submucosa in selected cases) whereas deeper invasion makes endoscopic therapy infeasible.Endoscopic mucosal resection(EMR,piecemeal for LSTs > 20 mm,en bloc for smaller neoplasms) remains the first-line therapy for NPTs,whereas endoscopic submucosal dissection in high-volume centers or surgery should be considered for large LSTs for which en bloc resection is mandatory and cannot be achieved by means of EMR.After piecemeal EMR,follow-up colonoscopy should be performed at 3 mo to assess resection completeness.In case of en bloc resection,surveillance colonoscopy should be scheduled at 3 years for adenomatous lesions
文摘目的探讨内镜保胆取息肉术治疗胆囊息肉样病变(PLG)的疗效。方法回顾性分析2012年1月至2017年1月期间新疆军区总医院395例病理诊断为胆固醇性PLG患者的临床资料。其中行内镜取息肉术216例,行腹腔镜胆囊切除术(LC)179例。比较两组患者围术期指标、并发症发生率,观察两组远期疗效。结果两组术前资料具有可比性(P>0.05)。内镜取息肉术组手术时间[M(P25,P75),58(52,67)min vs 59(56,70)min]、术中出血量[(12.9±5.2)m L vs(16.6±4.7)m L]、术后排气时间[(17.3±5.3)h vs(21.0±3.8)h]、下床活动时间[M(P25,P75),8(6,15)h vs 12(8,19)h]、住院时间[(6.9±1.5)d vs(7.3±1.3)d]、腹痛和腹泻发生率(1.39%vs 6.15%)、总并发症发生率(3.24%vs 12.85%),均明显低于LC组(Z/χ2:-2.195,7.262,7.953,-6.410,2.330,4.749,10.988;均P<0.05)。随访截至2018年1月,随访时间12~72个月,中位随访41个月,失访率:内镜取息肉术组9.26%(20/216),LC组8.94%(16/179)。随访6年内,内镜取息肉术组复发率6.63%(13/196),LC组肝内外胆管结石发生率1.23%(2/163)。结论对于PLG可能为胆固醇性且有手术指征或处于指征边缘的患者,若无法坚持定期复查,内镜取息肉术不失为手术治疗方法中的优选。
