Management of patients with polyps containing malignancy removed by colonoscopic polypectomy
Management of patients with polyps containing malignancy removed by colonoscopic polypectomy
复制标题
结肠镜息肉切除术切除含有恶性肿瘤的息肉患者的治疗
DOI：
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发表时间：
1984
影响因子：
3.9
通讯作者：
J. Cullen
中科院分区：
文献类型：
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作者：
J. Langer;Z. Cohen;B. Taylor;S. Stafford;K. Jeejeebhoy;J. Cullen
结肠镜下切除结肠恶性息肉的处理一直是一个有争议的话题。一个连续的系列报告36例37恶性息肉切除结肠镜息肉切除术（CP）在1976年和1982年之间。14例息肉含有原位癌（CIS）; 13例仅用CP治疗; 1例用CP和结肠切除术治疗。19例息肉含有浸润性癌; 13例单独用CP治疗; 6例用CP和结肠切除术治疗。4例患者的无蒂息肉切除零碎，其中准确的分期是不可能的。2例单纯CP治疗，2例CP加结肠切除术。所有患者每年进行结肠镜检查和/或钡灌肠检查。随访6 ~ 84个月，平均36个月。27例单纯用CP治疗息肉的患者在息肉切除部位没有复发肿瘤的证据。在9例接受结肠切除术的患者中，6例在息肉切除术切除部位有残留肿瘤。没有患者累及淋巴结。我们目前对这个问题的处理方法是基于侵犯的程度和切除边缘的状态。含有CIS的息肉可以单独用CP安全地治疗。息肉伴浸润性癌和清晰的切除边缘应采用CP和结肠切除术或频繁的重复结肠镜检查治疗。该决定是临床决定，必须涉及临床医生和病理学家的输入。那些息肉的切除边缘涉及或零碎切除排除准确的病理评估，应进行结肠切除术。
The management of malignant colonic polyps removed colonoscopically has been a controversial subject. A continuing series is reported of 36 patients with 37 malignant polyps removed by colonoscopic polypectomy (CP) between 1976 and 1982. Fourteen polyps contained carcinomain situ (CIS); 13 were treated by CP alone; one was treated by CP and colectomy. Nineteen polyps contained invasive carcinoma; 13 were treated by CP alone; six were treated by CP and colectomy. Four patients had sessile polyps resected piecemeal, in which accurate staging was impossible. Two were treated with CP alone, and two had CP plus colectomy. All patients were followed with yearly colonoscopy and/or barium enema. Follow-up has been six to 84 months (mean 36 months). Twenty-seven patients whose polyps were treated by CP alone have had no evidence of recurrent tumor at the polypectomy site. Of the nine patients undergoing colectomy, six had residual tumor at the polypectomy resection site. No patients had involved lymph nodes. Our current approach to this problem is based on the degree of invasion and the status of the resection margins. Polyps containing CIS can safely be treated with CP alone. Polyps with invasive carcinoma and clear resection margins should be treated with CP and either colectomy or frequent repeat colonoscopy. This decision is a clinical one and must involve input from both the clinician and the pathologist. Those polyps whose resection margins are involved or where piecemeal excision precludes accurate pathologic assessment should undergo colectomy.