内镜下卢戈液染色与P53蛋白检测诊断早期食管癌  

Lugol's staining with p53 oncoproteins in detecting early esophageal cancer

作　　者：魏子白[1] 王丽冰[1] 田步生[1] 王金龙[1] 孙旭芳[1] 魏建平[1] 刘娜[1] 王敬弘[1] 

机构地区：[1]长治医学院附属和平医院胃镜室,山西省长治市046000

出　　处：《世界华人消化杂志》2001年第5期495-498,共4页World Chinese Journal of Digestology

摘　　要：目的研究内镜下卢戈液染色和活组织p53检测诊断食管早期癌和表浅癌的可行性。方法将97例食管癌手术标本先用卢戈液染色,然后对粘膜不染色区行P53蛋白免疫组化染色;并对78例可疑早期食管癌患者行内镜下卢戈液染色,粘膜不染色区活检结果为重度不典型增生细胞者行P53蛋白免疫组化染色,最后对P53蛋白阳性的病灶行内镜下粘膜切除术。结果在97例食管癌手术标本中,共有63处直径>2mm的粘膜不染色区,其中正常粘膜2处,单纯增生7处,不典型增生42处,原位癌1处,鳞状细胞癌11处;P53蛋白的阳性表达主要发生在重度不典型(42.3％)和鳞状细胞癌(45.5％)的细胞核内,而在正常粘膜、单纯增生和轻～中度不典型增生组织中几乎无表达(P<0.05);在78例患者中,共发现25例患者存在31处粘膜不染色区,其中单纯增生上皮1处,轻度不典型增生2处,中度不典型增生9处,重度不典型增生16处,鳞状细胞癌3处,对7例P53蛋白表达阳性的重度不典型增生粘膜行内镜下粘膜切除术后,1例被证实为粘膜内癌。结论卢戈液染色和活组织P53蛋白检测不仅对诊断早期食管癌有帮助,而且对重度不典型增生组织行内镜下粘膜切除术有指导意义。AIM To evaluate the feasibility of Lugol's iodine staining combined with p53 oncoproteins in detecting early, superficial esophageal cancer by upper gastrointestinal endoscopy. METHODS Lugol's iodine was sprayed on 97 surgically resected specimens of esophageal cancer, p53 oncoprotein of small areas unstained by Lugol's iodine (larger than 2mm in diameter) were studied Immunohistochemically; Lugol's iodine was sprayed on esophageal mucosa in 78 patients suspected early malignancy. Severe dysplasia which taken from unstained by iodine were prepared immunohistochemically for p53 oncoprotein study. Endoscopic mucosel resection (EMR) was performed to these severe dysplasa with p53 oncoprotein-positive mucosa. PESULTS There were 63 small areas unstained by Lugols iodine, including 42 dysplasias, 1 carcinoma in situ, 11 squamous cell carcinomas; p53 expression was more often found in severe dysplasias and carcinomas (45.5% ) than in normal mucosa and mild-to-moderate dysplasias (P<0.05). There were 31 areas (25 patients) unstained Includlng squamous cell carcinomas (n=3) and severe dysplaslas (n=16). Expression of p53 was found in 7 severe dysplasia (43.8%) and 1 carcinoma in situ was found by EMR. CONCLUSION This modified method seemed feasible not only to detect early esophageal cancer, but also to resect severe dysplasia mucosa.

关 键 词：食管肿瘤 诊断 病理学 蛋白质P53 卢戈液染色法 内窥镜检查 消化系统 

分 类 号：R735.1[医药卫生—肿瘤]