摘要目的 探讨内镜下无法切除的结直肠息肉的特征和外科治疗策略.方法 回顾性分析2006年8月至2012年7月在中山大学附属第三医院胃肠外科行手术治疗的40例内镜下无法切除的结肠和高位直肠息肉患者的临床资料,应用单因素和多因素Logistic分析方法对可能影响息肉恶变的因素进行筛选,应用t检验和x2检验对比开腹和腹腔镜下结直肠肠段切除+淋巴结清扫术的长短期预后数据.结果 息肉恶变率为67.5％(27/40),与息肉恶变密切相关的是患者年龄和息肉个数(均P＜0.01).开腹和腹腔镜下结直肠肠段切除+淋巴结清扫术两种术式在手术失血量[(86±58) ml比(44 ±32)ml,P=0.0066]、恢复肛门排气时间[(2.7±1.3)d比(1.7±0.6)d,P=0.0018]、并发症发生率(2例比0例,P =0.0365)和住院时间[(11.2±1.0)d比(15.0±5.0)d,P=0.0164]方面差异均有统计学意义,在总生存率和无瘤生存率方面的差异均无统计学意义[90.9％(10/11)比100.0％(27/27)、90.9％(10/11)比96.3％(26/27),均P＞0.05].结论 内镜下无法切除息肉有高恶变率,息肉恶变多见于高龄患者和多发息肉患者.腹腔镜下结直肠肠段切除+淋巴结清扫术比开腹手术的短期预后更好,长期疗效相仿,应作为内镜下无法切除息肉的首选术式.

abstractsObjective To explore the characteristics and risks of cancer in endoscopically unresectable polyps and compare the surgical outcomes of different operations.Methods A retrospective review of 40 patients undergoing surgical operations for polyps unresectable at colonoscopy between August 2006 and July 2012 from Department of Grastronintestinal Surgery was performed.The follow-up period was 3 to 72 months (median:24.5 months).Results The rate of endoscopically unresectable polyps with invasive cancer was 67.5％ (27/40).And it was significantly influenced by patient age and number of polyps (both P ＜ 0.01).Perioperative volume of blood loss ((86 ± 58) ml vs (44 ± 32) ml,P =0.0066),time to first flatus ((2.7 ± 1.3)d vs (1.7 ±0.6)d,P =0.0018),incidence of complication (2 cases vs 0,P=0.0365) and hospital stay ((11.2±1.0)d vs (15.0±5.0)d,P=0.0164) were significantly different between open coletomy and laparoscopic group.And the long-term survival outcomes were similar in both groups (90.9％ (10/11) vs 100.0％ (27/27),90.9％ (10/11) vs 96.3％ (26/27),both P ＞ 0.05).Conclusions Endoscopically unresectable polyps of colon and rectum have high malignance rate.Polyps in elderly patients and multiple polyps are more likely to develop invasive cancer.Long-term outcomes are similar between open coletomy and laparoscopic coletomy groups,but laparoscopic group has better shortterm outcomes.For endoscopically unresectable polyps,laparoscopic coletomy may be the first choice.