Clinical effect of endoscopic mucosal resection by injection method in the treatment of laterally spreading tumor
ZHI Zhong-jing1 CHEN Mu-wei1 LYU Jian-guang2 SHAO Shao-wei3 TA Shi-nian1 TAN Fei-ou1
1.Department of Gastroenterology,Zhaoqing No.2 People′s Hospital of Guangdong Province,Zhaoqing 526020,China;
2.Department of Medical Imagery,Zhaoqing No.2 People′s Hospital of Guangdong Province,Zhaoqing 526020,China;
3.Department of Pathology,Zhaoqing No.2 People′s Hospital of Guangdong Province,Zhaoqing 526020,China
Abstract：Objective To evaluate the clinical effect of endoscopic mucosal resection (EMR)by injection method in the treatment of colorectal laterally spreading tumor(LST).Methods 32 patients with LST treated with EMR from July 2014 to December 2015 in our hospital were selected as the EMR group,all the specimens were treated with standardized methods,and the whole tumor was evaluated.90 patients with LST treated by conventional electrocoagulation,argon ion coagulation and surgical operation in our hospital from July 2010 to July 2014 were selected as the conventional treatment group.Patients of the two groups were followed up at 3,6 months and 12 months after operation,and the efficacy and safety of EMR were evaluated.Results All patients were successfully treated and followed up,all 32 patients of the EMR group received complete pathological specimens,and the pathological results showed that 18 cases of tubular adenoma,9 cases of villous tubular adenoma,3 cases of villi tumor,and 2 cases of mucinous carcinoma.Among the 2 cases of mucinous carcinoma,1 case of the postoperative pathological specimen showed lesion-free residual tumor at 2 mm margin;additional surgery was not needed;another 1 case showed residual tumor,with additional surgery;the complete resection rate was 96.9%.No intraoperative perforation was observed.Hemorrhage occurred in all 3 patients,and the microscopic hemostasis was successful.Among patients of the conventional treatment group,only 15 cases received complete specimens,which were all surgical cases,showing adenoma.Among them,10 cases were tubular adenoma,3cases were villous tubular adenoma,and 4 cases were villi tumor;bleeding was shown in 2 patients receiving surgery.Intraoperative hemostasis was successful in both patients,and the secondary open surgery was not needed.The recurrence rates at 3 months after the surgery of the EMR group and conventional treatment group (0.00%vs.3.33%)had no statistically significant difference (P＞0.05),while recurrence rates at 6,12 months after the surgery (6.25%vs.28.90%, 9.40%vs.37.80%)had statistically significant difference(P＜0.01).Conclusion EMR can treat most of the patients with LST observed clinical microscopic.Compared with the traditional treatment,it has the advantages of exact curative effect, less traumatic,low recurrence rate,complete specimens and other advantages,which is worthy of clinical promotion.
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