黏膜下切除术联合色素内镜在早期胃癌诊断中的临床应用研究  

Clinical values of ESD and chromoendoscopy in early gastric cancer and precancerous lesion

作　　者：周彩芳[1] 刘铁梅[1] 

机构地区：[1]复旦大学附属中山医院青浦分院内窥镜室,上海201700

出　　处：《哈尔滨医科大学学报》2014年第1期62-65,共4页Journal of Harbin Medical University

基　　金：上海市青浦区科学技术发展基金项目资助(青科发2012-19)

摘　　要：目的探讨黏膜下切除术(ESD)联合色素内镜在早期胃癌诊断中的临床应用价值。方法 195例患者行常规内镜检查,对胃黏膜可疑病灶进行多处活检;然后进行醋酸-靛胭脂染色,比较常规内镜和色素内镜下病灶边界清晰程度,并作出染色后诊断,取活检标本。对疑诊早期胃癌的病变,行ESD后送检病理,观察病变大小、病理诊断和侵犯深度。结果在195例胃黏膜可疑病灶进行活检的病例中,早期胃癌和癌前病变检出为17例,检出率为8.72%(17/195);胃黏膜异常染色病例中,早期胃癌和癌前病变检出为66例,检出率为33.84%(66/195),明显大于前者(P<0.05)。胃黏膜异常染色病例中早期胃癌和癌前病变检出包括所有常规内镜检查对早期胃癌和癌前病变检出病例。在66例早期胃癌和癌前病变中,癌前病变49例(74.24%),分化型和未分化型早癌17例(25.76%)。行黏膜下切除术术后,切除组织送检病理,癌前病变38例(57.58%),分化型和未分化型早癌28例(42.42%),行ESD术后送检标本早期胃癌检出率高于活检钳活检检出率(P<0.05)。结论 ESD联合色素内镜能够指导内镜下胃黏膜病变的活检,提高早期胃癌和癌前病变的检出率。Objective To investigate the clinical value of ESD and chromoendoscopy in the de- tection of early gastric cancer and precancerous lesions. Methods One hundred and ninety- five patients underwent endoscopy, with gastric mucosal of suspicious lesions biopsies. After acetic acid joint indigo carmine dyeing, the edge of suspected early gastric cancer and precan- cerous lesions was identified. After endoscopic submucosal dissection, the form of lesions, cryp- topenings, and the laterally developmental border were observed. Results In 195 cases of gastric suspicious lesions, 17 eases of early gastric cancer and precancerous lesions were found, and the detection rate was 8.72% （ 17/195 ） ; 66 cases of early gastric cancer and precancerous lesions were found by staining, and the detection rate was 33.84% （66/195） , greater than the former significantly （P 〈 0. 05 ）. The detection of mucosal abnormalities cases of early gastric cancer and precancerous lesion by staining included all the cases of conventional endoscopy. In66 cases of early gastric cancer and precancerous lesions, 49 cases were precancerous lesions （74.24%）, 17 cases were differentiated and undifferentiated carcinoma （25.76%）. In the removal tissue pathology after submucosal resection （ESD） surgery, 38 cases are precancerous lesions （57.58%）, 28 cases were differentiated and undifferentiated type early cancer （42. 42% ）. The early gastric cancer detection rate by ESD was higher than that by biopsy for- ceps biopsy （P 〈 0. 05 ）. Conclusion ESD combined chromoendoscopy can guide biopsy, and improve detection rate of early cancer and precancerous lesion.

关 键 词：黏膜下切除术 色素内镜 醋酸一靛胭脂染色 病理学诊断 

分 类 号：R730.49[医药卫生—肿瘤] R735.2[医药卫生—临床医学]