Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy.
Combined endoscopic and laparoscopic surgery may be an alternative to bowel resection for the management of colon polyps not removable by standard colonoscopy.
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内窥镜和腹腔镜联合手术可能是肠切除术的替代方案，用于治疗标准结肠镜检查无法切除的结肠息肉。
DOI：
10.1007/s00464-012-2714-5
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Yoo,James
中科院分区：
文献类型：
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作者：
Lee,MinnaK;Chen,Formosa;Esrailian,Eric;Russell,MarciaMcGory;Sack,Jonathan;Lin,AnneY;Yoo,James
如果内镜下息肉切除术不能充分评估癌症，则良性结肠息肉可能需要肠切除术。然而，内镜下切除仍然可能使用联合内镜和腹腔镜手术（CELS）。CELS手术允许肠壁的腔内和腔外操作，以促进息肉切除，从而避免肠切除。本研究评估了作者的机构经验与CELS在此patientpopulation.MethodsBetween 2008年8月和2012年10月，所有患者提到接受手术的良性结肠息肉进行回顾性审查的手术特点，病理和术后结果。在14例患者中，有5人被认为是候选人CELS和9例患者进行了比较，接受surgence.ResultsThe患者的平均年龄是两组（CELS，64.9年与切除术，68.3年）之间相似。CELS组的平均息肉尺寸为2.3 cm，切除组为2.9 cm。在CELS组中，所有病例均成功切除息肉。CELS组的平均手术室时间为159分钟，切除组为205分钟。CELS组的中位住院时间为1天，切除组为5天。CELS组无并发症发生。切除组2例患者（22%）发生伤口感染。1例患者发生术后肠梗阻（11%）。CELS组中有4例患者患有良性腺瘤。1例患者进行了良性冷冻切片评价，但最终病理学显示腺癌，需要随后进行结肠切除术。在切除组中，6名患者患有良性腺瘤，3名患者患有T1N0癌症。在CELS组中，CELS后平均9.9个月进行重复内镜检查。2例患者有残留息肉，2例患者在不同位置有新息肉。所有人都成功地removed.ConclusionFor良性出现的息肉不适合单独的内镜技术，CELS可能是一种替代正式肠切除术精心挑选的患者。CELS手术可以安全地进行，发病率最低，结局与正式结肠切除术相比更有利。
BackgroundBenign colon polyps may require bowel resection if endoscopic polypectomy cannot be performed to assess adequately for cancer. However, endoscopic removal still may be possible using combined endoscopic and laparoscopic surgery (CELS). The CELS procedure allows for intra- and extraluminal manipulation of the bowel wall to facilitate polyp removal, thereby avoiding bowel resection. This study evaluated the authors’ institutional experience with CELS in this patient population.MethodsBetween August 2008 and October 2012, all patients referred to undergo surgery for a benign colon polyp were retrospectively reviewed for operative characteristics, pathology, and postoperative outcomes. Of 14 patients, five were considered candidates for CELS and were compared with nine patients who underwent resection.ResultsThe average patient age was similar between the two groups (CELS, 64.9 years vs. resection, 68.3 years). The mean polyp size was 2.3 cm in the CELS group and 2.9 cm in the resection group. In the CELS group, polyps were successfully removed in all cases. The mean operating room time was 159 min in the CELS group and 205 min in the resection group. The median hospital stay was 1 day in the CELS group and 5 days in the resection group. No complications occurred in the CELS group. Two patients in the resection group (22 %) experienced a wound infection. One patient had a postoperative ileus (11 %). Four patients in the CELS group had a benign adenoma. One patient had a benign frozen section evaluation, but the final pathology showed adenocarcinoma requiring a subsequent colectomy. In the resection group, six patients had a benign adenoma, and three patients had a T1N0 cancer. In the CELS group, repeat endoscopy was performed an average of 9.9 months after CELS. Two patients had a residual polyp, and two patients had new polyps in a different location. All were successfully removed.ConclusionFor benign-appearing polyps not amenable to endoscopic techniques alone, CELS may be an alternative to formal bowel resection for carefully selected patients. The CELS procedure can be performed safely with minimal morbidity and with outcomes that compare favorably with those of formal colectomy.