胃黏膜活检高级别上皮内瘤术前超声内镜检查应用价值的研究  

Endoscopicultrasonography guided treatment of gastric biopsy specimens of high grade intraepithelial neoplasia

作　　者：田书信[1] 郑勇[1] 陈卫刚[1] 陈世耀[2] 黎永军[1] 徐丽红[1] 刘清华[1] 李睿[1] 韩岩智[1] 刘芳[1] 郑义[1] 阮开学[1] 尚国臣[1] 赵瑾[3] 牛建华[4] 

机构地区：[1]石河子大学医学院第一附属医院消化内科,新疆石河子832008 [2]复旦大学中山医院消化内镜中心,上海200032 [3]石河子大学医学院第一附属医院病理科,新疆石河子832008 [4]石河子大学医学院第一附属医院普外科,新疆石河子832008

出　　处：《中国内镜杂志》2012年第10期1009-1013,共5页China Journal of Endoscopy

基　　金："十一五"国家科技支撑计划资助项目(No.2009BAI82B05)

摘　　要：目的探讨超声内镜(EUS)对活检胃黏膜高级别上皮内瘤(HGIEN)病变浸润深度的术前判定的准确性研究。方法选取近3年104例胃黏膜活检组织示HGIEN患者,术前行EUS检查初步判断病变浸润深度,根据EUS术前分期的结果指导行黏膜下剥离术(ESD)或外科手术治疗。观察术后病理结果,比较EUS对病变浸润深度判断的准确率。结果 104例患者术前EUS示:34例局限在黏膜层病变考虑为早期胃癌,其中有32例行ESD,2例选择行外科手术,有30例术前EUS诊断结果与术后病理检查病变浸润深度符合,在该组EUS检查阳性预测值88.2%(30/34);70例为低回声病变浸润至肌层以外考虑为进展期胃癌,对其行外科手术治疗,有65例EUS诊断与术后病理检查病变浸润深度符合,EUS对非早期胃癌检查阴性预测值92.9%(65/70)。结论活检组织胃黏膜HGIEN术前行EUS检查,EUS诊断结果对病变浸润深度具有较高的准确性,对手术方式的选择有一定的指导意义。[Objective] This research is to explore the influence of EUS on treatment of gastric biopsy specimens of HGIEN.[Methods] 104 patients with gastric biopsy of HGIEN in recent 3 years were diagnosed by preoperative EUS,according to the preoperative staging EUS results suggested with ESD or surgery.The pathological findings of post-procedures and the consistence were analyzed at endpoints of the study between EUS and the pathological findings.[Results] A total of 104 patients with preoperative EUS were collected.34 patients whose lesions limited to the mucosa were early gastric cancer,30 patients underwent ESD and the other 2 patients received surgical treatments,and consistency of invasion depth between postoperative pathological diagnosis and preoperative staging,in the group EUS positive with predictive value of 88.2%（30/34）.70 patients whose EUS showed the hypoechoic pattern lesion invasive outside the of muscle are confirmed infiltrative gastric carcinoma and were performed with surgery.The EUS results of 65 patients were consistent with postoperative pathological diagnosis.The negative,predictive value was 92.9%（65/70） by EUS.[Conclusion] We should do EUS before the operation on patients whose guidance of gastric mucosal biopsy showing HGIEN.Its results have a high accuracy of the depth of lesions invasion.EUS shows certain significance in operation method guidance of gastric mucosal biopsy showing HGIEN.

关 键 词：胃肿瘤 上皮内瘤变 超声内镜 黏膜下剥离术 治疗 

分 类 号：R57[医药卫生—消化系统]