内镜活检与外科病理在上消化道恶性肿瘤诊断上的差异  

Error analysis for endoscopic biopsy on diagnosis of upper gastro-intestinal malignant tumors

作　　者：徐莉[1] 张亚历[2] 黎卫[1] 郭文[2] 

机构地区：[1]广东省中山市人民医院内科,广东省中山市528403 [2]中国人民解放军第一军医大学南方医院全军消化内科研究所,广东省广州市510515

出　　处：《世界华人消化杂志》2000年第6期658-660,共3页World Chinese Journal of Digestology

摘　　要：目的探讨术前内镜粘膜活检对恶性病变的诊断价值及其与外科病理诊断的差异.方法对经内镜活检并经外科切除的199例上消化道恶性肿瘤标本进行组织病理学对照分析,探讨活检对恶性肿瘤的确诊率及其与内镜下粘膜形态、组织学类型的关系,比较其与外科病理诊断在肿瘤的分化程度判断上的差别.结果上消化道内镜活检确诊率79.4%,疑诊11.1%,未能诊断者占9.5%.活检确诊率以肿块型病变确诊率最高,溃疡型次之,弥漫僵硬型和狭窄型病变内镜活检确诊率较低.就组织学类型而言,以鳞癌和腺癌检出率较高,分别达88.3%和79.6%.对腺鳞癌、类癌及未分化癌检出率较低,对平滑肌肉瘤等活检对恶性判断的意义不大.结论内镜活检虽在术前对上消化道恶性肿瘤诊断有决定性的意义,但是由于取材所限,反映病变性质不够全面,对恶性肿瘤诊断存在一定误差.AIM To investigate the diagnostic differences by pre- operative endoscopic biopsy and post-operative histopethological specimen. METHODS A total of 199 cases of the upper gastrointestinal malignant tumors from 1995 to 1997 were reviewed.All the cases were analyzed by both biopsy and surgical histopathology.The accuracy rate for malignancy and error factors affecting the diagnosis were investigated and compared with the results of the pathological evaluation. RESULTS The established diagnostic rate by endoscopic biopsy was 79.4%,suspected rate 11.1% and uncertain 9.5%,They were easily diagnosed by biopsy in the lesions with projective or ulcerative morphology under endoscopy,but diagnosis was difficult in rigid or stenosis mucosal lesion,especially for leiomyosarcoma and malignant lymphoma. CONCLUSION Errors existed by means of endoscopic biopsy on identification of upper gastrointestinal malignant tumors,though biopsy is a very useful tool in pre operative diagnosis.

关 键 词：消化系统肿瘤 病理学 诊断 窥镜 活组织检查 

分 类 号：R735[医药卫生—肿瘤]