胃黏膜病变内镜下形态与内镜活检准确率的关系  

Relation between gastric mucosal lesion morphology under endoscope and its endoscopic biopsy accuracy

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

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《军医进修学院学报》2012年第6期613-615,621,共4页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探讨胃黏膜病变内镜下形态与内镜活检符合率的关系。方法回顾性分析2006-2011年间因胃黏膜病变在我院行内镜黏膜剥离术的266例患者相关资料,对其中234例(246处病灶)内镜活检病理诊断为上皮内瘤变或早癌患者进行胃黏膜病变与内镜活检的差异分析。结果内镜活检病理与术后病理均提示有瘤变或癌变的总符合率达94.3%(232/246),不同形态胃黏膜病变总符合率分别为I型91.7%(22/24)、IIa型90.9%(70/77)、IIb型94.4%(17/18)、IIc型95.7%(22/23)、IIa+IIc型98.1%(102/104)。其中内镜活检与术后病理诊断完全一致的占51.6%(127/246),以IIa型病变完全一致率最高(P<0.05),达67.5%(52/77);术后病理较活检病理级别升高的占33.7%(83/246),以IIc型病变术后病理级别升高率最高(P<0.05),达52.2%(12/23);术后病理较活检病理级别降低的占8.9%(22/246),以IIa型病变术后病理级别降低率最高,达13.0%(10/77)。术后病理为炎性组织的占5.7%(14/246),其中I型有8.3%(2/24)、IIa型9.1%(7/77)、IIb型5.6%(1/18)、IIc型4.3%(1/23)、IIa+IIc型1.9%(2/104)。结论根据胃黏膜病变内镜下形态表现判断其活检病理的准确率具有一定可行性。Objective To study the relation between gastric mucosal lesion morphology under endoscope and its endoscopic biopsy accuracy.Methods Data about 266 patients undergone endoscopic submucosal dissection（ESD） for gastric mucosal lesions in our hospital from 2006 to 2011 were retrospectively analyzed.Difference was observed between gastric mucosal lesion and its endoscopic biopsy in 234 patients with 246 lesions diagnosed as gastric intraepithelial neoplasia（IEN） or early cancer out of the 266 patients.Results Endoscopic biopsy and postoperative pathology showed that the total accordance rate for IEN or cancer and types I,IIa,IIb,IIc and IIa＋IIc gastric mucosal lesions was 94.3%（232/246）,91.7%（22/24）,90.9%（70/77）,94.4%（17/18）,95.7%（22/23） and 98.1%（102/104）,respectively.The complete accordance rate of endoscopic biopsy and postoperative pathology was 51.6%（127/246） for the lesions,especially for type IIa lesion [67.5%（52/77）].The grade of postoperative pathology was higher than that of endoscopic biopsy for the lesions [33.7%（83/246）],especially for type IIc lesion [52.2%（12/23）].The grade of pathology was lower than that of endoscopic biopsy for lesions [8.9%（22/246）],especially for type IIa lesions [13.0%（10/77）],and 5.7%（14/246） of the lesions were diagnosed as gastritis by postoperative pathology,including 8.3%（2/24） of type I lesions,9.1%（7/77） of type IIa lesions,5.6%（1/18） of type IIb lesions,4.3%（1/23） of type IIc lesions and 1.9%（2/104） of type IIa＋IIc lesions.Conclusion It is possible to estimate the accuracy of endoscopic biopsy in diagnosis of gastric mucosal lesion according to its morphology.

关 键 词：胃黏膜 癌前病变 活检准确率 

分 类 号：R573[医药卫生—消化系统]