术前活检在胃黏膜病变内镜黏膜下剥离术治疗中的价值分析  

Preoperative biopsy in the treatment of gastric mueosal lesions by endoscopic submucosal dissection

作　　者：张游[1] 令狐恩强[1] 卢忠生[1] 杜红[1] 王向东[1] 孟江云[1] 王红斌[1] 

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《中华消化内镜杂志》2012年第3期151-154,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价术前活检在胃黏膜病变内镜黏膜下剥离术（ESD）治疗中的应用价值。方法对195例术前活检明确诊断为胃上皮内瘤变或早癌患者的临床资料进行回顾性总结，统计术前活检诊断与ESD术后病理诊断的差异性。结果术前活检与术后病理总符合率达93．8％（183／195），完全一致率为50．8％（99／195），其中低级别上皮内瘤变完全一致率为49．4％（42／85），高级别上皮内瘤变完全一致率为38．O％（30／79），早癌完全一致率为87．1％（27／31），早癌诊断一致率明显高于低级别上皮内瘤变和高级别上皮内瘤变（P〈0．05），而低级别上皮内瘤变诊断一致率与高级别上皮内瘤变比较差异无统计学意义（P〉0．05）。有66例（33．8％，66／195）术后病理较术前活检病理程度加重，其中低级别上皮内瘤变有36例（42．4％，36／85），高级别上皮内瘤变有30例（38．0％，30／79）；有18例（9．2％，18／195）术后病理较术前活检病理程度减轻，其中高别上皮内瘤变有14例（17．7％，14／79），早癌有4例（12．9％，4／31）；术后病理证实为炎性组织12例（6．2％，12／195），其中低级别上皮内瘤变有7例（8．2％，7／85），高级别上皮内瘤变有5例（6．3％，5／79）。结论术前活检病理结果不能完全代表胃黏膜病变的性质，但术前活检病理对ESD切除胃黏膜病变具有良好的提示作用。Objective To evaluate preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection （ESD）. Methods Clinical data of 195 patients diagnosed as having gastric intraepithelial neoplasia （GIEN） or early cancer by preoperative biopsy were retrospectively ana- lyzed. The discrepancy between endoscopic biopsies and pathological diagnosis after ESD were studied. Results The overall consistency rate between preoperative biopsies and postoperative pathological diagno- sis was 93.8% （183/195） and complete consistency rate was 50. 8% （99/195）. For low-grade and high- grade gastric intraepithelial neoplasia （LGIEN） , the complete consistency rates were 49. 4% （42/85） and 38.0% （30/79） , respectively, which were not different （P 〉0.05）. For early cancer it was 87.1% （27/31）, which was significantly higher than those in the LGIEN group and HGIEN group （P 〈 0. 05 ）. Post-ESD diagnosis was more severe than biopsy in 66 patients （33.8% , 66/195 ）, including 36 LGIEN （42. 4%, 36/85 ） and 30 HGIEN （38.0%, 30/79）. Final pathological diagnosis was milder than biopsy in 18 patients （9.2%, 18/195）, i.e. 14 HGIEN （17.7%, 14/79） and 4 early cancer （12.9%, 4/31 ）. Gastritis was diagnosed in 12 patients （ 6.2%, 12/195 ）, i.e. 7 LGIEN （ 8.2%, 7/85 ） and 5 HGIEN （6. 3%, 5/79）. Conclusion Preoperative biopsy is insufficient for accurate diagnosis of gastric mucosal lesions, but facilitates resection of gastric mucosal lesions by ESD.

关 键 词：上皮内瘤变 早癌 活检 内镜黏膜下剥离术 病理 

分 类 号：R737.33[医药卫生—肿瘤]