Résumé
Objective To analyze the pathological types of colorectal flat polyps after endoscopic mucosal resection (EMR),and explore the risk factors of high-risk fiat adenomatous polyps.Methods The retrospective case-control study was conducted.The clinicopathological data of 245 patients with colorectal fiat polyps who were admitted to the People's Hospital of Xinjiang Uygur Autonomous Region between February 2010 and April 2016 were collected.All the patients underwent EMR,and incision tissues were diagnosed by pathological examination.Observation indicators:(1) clinical features and results of pathological examination of flat polyps;(2) risk factors analysis of high-risk flat adenomatous polyps.Measurement data with normal distribution were represented as (x)±s.The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Clinical features and results of pathological examination of flat polyps:flat polyps located in the cecum,ascending colon,transverse colon,descending colon,sigmoid colon and rectum were detected in 12,26,55,35,73 and 44 patients,respectively.Of 245 patients,153 were combined with multiple polyps.The diameter of fiat polyps was (0.9±0.8)cm.Results of pathological examination of 245 patients:108,40,18,25,14,3,12,12 and 13 patients were diagnosed with as tubular adenomas with low-grade intraepithelial neoplasias (LGINs),tubulovillous adenomas with LGINs,tubulovillous adenomas with high-grade intraepithelial neoplasias (HGINs),tubular adenomas with HGINs,adenocarcinomas (T1 stage),neuroendocrine tumors,serrated polyps,mucosal chronic inflammation and hyperplastic polyps,respectively.(2) Risk factors analysis of high-risk fiat adenomatous polyps:the results of univariate analysis showed that age,number and diameter of polyps were the related factors related factors affecting the occurrence of high-risk fiat adenomatous polyps (x2 =8.920,5.455,36.901,P＜0.05).The results of multivariate analysis showed that age ＞ 60 years old and diameter of polyps ＞ 1 cm were the independent risk factors affecting occurrence of high-risk fiat adenomatous polyps (Odds ratio =2.681,8.162,95％ confidence interval:1.481-4.856,3.786-17.597,P＜0.05).Conclusion The main colorectal fiat polyps are adenomatus polyps,and age ＞ 60 years old and diameter of polyps ＞1 cm are the independent risk factors affecting occurrence of high-risk fiat adenomatous polyps.
Résumé
Introducción: Recientemente se ha desarrollado un accesorio para la disección submucosal endoscópica (DSE) que combina un jet de agua ultrafino de alta presión para la hidrodisección submucosal con un electrocauterio. Objetivo: Mostrar la experiencia inicial con el uso del ERBE Hybrid Knife para la DSE. Materiales y pacientes: Se incluyen 2 pacientes con adenomas planos extendidos lateralmente de colon y recto, a quienes se les realizó DSE con el ERBE Hybrid Knife como instrumento único y la fuente electroquirúrgica ERBE VIO-200 D. Se marcó el área utilizando coagulación (FORCED COAG). El jet de agua de alta presión se usó en forma intermitente para elevar la submucosa durante el proceso de disección a una presión entre 45 y 60 bar. Luego se hizo una incisión circunferencial en la mucosa y se realizó la disección submucosal usando los modos FORCED COAG Y ENDOCUT D del mismo accesorio. Resultados: Las lesiones estaban localizadas en sigmoides y recto bajo, de 1,5 y 3 cm de diámetro respectivamente, las cuales fueron resecadas en su totalidad en un solo segmento. El tiempo promedio utilizado fue de 65 minutos. Los procedimientos fueron realizados con sedación profunda asistida por anestesiólogo. No hubo complicaciones mayores. La histología de las lesiones fue adenoma tubulovelloso de colon con displasia leve y adenoma plano de recto. Conclusión: El ERBE Hybrid Knife es una alternativa para realizar la DSE, simplificando la técnica al usar un solo instrumento. Se deben hacer estudios prospectivos para medir el impacto en la estandarización de la técnica.
Introduction: Recently there has been developed an accessory for endoscopic submucosal dissection (ESD) that combines an ultra-thin water jet high pressure for a submucosal hydrodissection with an electrocautery. Aim: initial experience with the use of ERBE Hybrid Knife for the DSE. Materials and patients: The study included 2 patients with laterally spreading flat adenomas of the colon and rectum, who underwent ESD with ERBE Hybrid Knife as a single instrument and ERBE VIO electrosurgical source-200 D. It was marked the area using coagulation (FORCED COAG). The jet of high pressure water was used intermittently to raise the submucosa during the dissection at a pressure between 45 and 60 bar. Then, a circumferential incision in the mucosa and the submucosal dissection were performed with modes ENDOCUT D and FORCED COAG of the same accessory. Results: The lesions were located in lower rectum and sigmoid colon, 1.5 and 3 cm in diameter respectively, which were resected in its entirety as a single segment. The mean time spent was 65 minutes. The procedures were performed with deep sedation assisted by an anesthesiologist. There were no major complications. The histology of the lesions was tubulovillous adenoma with mild dysplasia colon and rectal adenoma plane. Conclusion: The ERBE Hybrid Knife is an alternative for the ESD, simplifying the technique of using a single instrument. Prospective studies should be made to measure the impact on the standardization of the technique.