目的 比较不同组织学特征的大肠息肉样恶性肿瘤单纯内镜下切除和 (或 ) 手术切除治疗的远期结果，为选择适宜治疗方案提供依据。方法 观察单纯内镜下切除的 39例和 (或 )手术切除的 22例大肠息肉样恶性肿瘤的组织学特征和治疗效果，平均随访时 间 64个月。结果 死于该病 1例，复发 2例，转移 1例。这些病例分布在单纯内镜下切除 和追加手术切除组间无统计学差异，无蒂息肉组高于有蒂息肉组 (P=0.006)；具备浸润局限 在粘膜肌层以内、有蒂息肉颈部未受累、切除边缘干净、分化中等以上等组织学特征的大肠 息肉样恶性肿瘤显著低于缺乏这些特征者 (P=0.002 )。 结论 大肠息肉样恶性肿瘤具备 如上组织学特征者可单纯内镜下切除并密切随访，反之则应追加手术切除。 Objective To compare the long-term results of endoscopic resection and/or surgical resection of colorectal polypoid malignancies with different histological features to provide the basis for selecting appropriate treatment options. Methods The histological features and therapeutic effects of colorectal polypoid malignancies in 39 patients undergoing simple endoscopic resection and/or surgical resection were observed. The average follow-up time was 64 months. Results One patient died of the disease, 2 patients relapsed, and 1 patient metastasized. These cases were not distributed between simple endoscopic resection and additional surgical resection. There was no difference between sessile polyps group and pedunculated polyp group (P=0.006). Infiltration was limited to mucosal muscular layer and pedunculated polyp neck. Undiagnosed polypoid malignancies in the large intestine with no histopathological features such as uninvolved excision margins, clean margins, and moderate or above differentiation were significantly lower than those lacking these characteristics (P=0.002). Conclusion Patients with colorectal polypoid malignancies who have the above histological features can undergo simple endoscopic resection and close follow-up. Otherwise, they should receive additional surgical resection.