针对结直肠癌合并高风险性腺瘤可择期外科手术的患者，探讨内镜下治疗的合适时机。

收集2013年1月至2018年6月经山东省威海市立医院诊治结直肠癌合并高风险性腺瘤的患者88例，将患者分为二组。A组52例患者，伴发高风险性腺瘤共96枚，该组患者先行结直肠癌外科手术，术后半年内行内镜下高风险性腺瘤治疗；B组36例患者，伴发高风险性腺瘤共54枚，该组患者先行结直肠高风险性腺瘤内镜下治疗，1～2周后再行结直肠癌外科手术治疗。分别记录患者的术前情况，手术相关情况，术后3～36个月随访结肠镜检查、肿瘤复发情况。

A组患者外科术后切除腺瘤，其中4例患者腺瘤发生癌变，均行二次外科手术进行切除、另4例患者出现吻合口复发，行二次外科手术。B组患者术前腺瘤切除术中1例出现穿孔，行外科区段切除手术，另有2例术后病理亦为腺瘤癌变侵及黏膜下层>1 000 μm，行外科区段切除手术，术后复查未发现吻合口复发。两组患者二次外科手术发生率对比有统计学意义(P<0.001)。

针对结直肠癌合并高风险性腺瘤可择期外科手术的患者，先行内镜治疗结直肠腺瘤，1～2周后再行结直肠癌外科手术，可有效减少二次外科手术的发生，值得临床广泛推广。

To explore the appropriate time of endoscopic treatment for colorectal cancer patients with high-risk adenomawho could be operated on electively.

A total of 88 patients with colorectal cancer complicated with high-risk adenoma in Weihai Municipal Hospital from January 2013 to June 2018 were collected and divided into two groups.There were 52 patients in group A, with 96 high-risk adenomas. Patients in this group underwent surgery for colorectal cancer first, and endoscopic treatment for high-risk adenomas within six months after the operation; There were 36 patients in group B, with 54 high-risk adenomas. Patients in this group were first treated with colorectal high-risk adenomas under endoscopic treatment, and then received surgical treatment for colorectal cancer 1 to 2 weeks later. And record the patient's preoperative condition, surgery-related condition, Colonoscopy and tumor recurrence were followed up 3-36 months after operation.

In group A, the adenoma was resected after surgery, among which 4 patients developed cancerous adenomas and underwent secondary surgical resection.The other 4 patients had anastomotic recurrence and underwent secondary surgery. In group B, 1 case of perforation occurred during adenoma resection. and surgical section resection was performed, the other 2 cases also showedthe adenoma became cancerous and submucosa >1 000 μm, and underwent surgical segmental resection, and no recurrence of anastomotic stoma was found in postoperative reexamination. The incidence of secondary surgical operations between the two groups was statistically significant (P<0.001).

For patients with colorectal cancer combined with high-risk adenomas that can be surgically operated on, endoscopic treatment of colorectal adenomas first and colorectal cancer surgery 1 to 2 weeks latercan effectively reduce the occurrence of secondary surgical operations, is worthy of widespread clinical promotion.