食管黏膜病变术前胃镜活检及内镜黏膜下剥离术术后病理的异同  

The similarities and differences between the pathology of esophageal mucosa lesions of preoperative gastroscopic biopsy and postoperative ESD

作　　者：王实[1] 李兆申[1] 崔钊[2] 俞江平[2] 吴伟[3] 陈枭冲 

机构地区：[1]第二军医大学附属长海医院消化科,上海200433 [2]浙江省肿瘤医院内镜中心 [3]浙江省肿瘤医院病理科

出　　处：《中华消化内镜杂志》2015年第7期432-434,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的比较食管黏膜病变患者术前胃镜活检病理与内镜黏膜下剥离术（ESD）术后病理的异同。方法收集浙江省肿瘤医院2013年至2014年胃镜活检诊断为食管黏膜病变并行ESD治疗患者共110例，对比分析术前胃镜病理结果与术后ESD病理结果差异。结果术前活检病理与术后病理诊断完全符合率为61．8％（68／110），术后病理程度较术前病理严重占30．0％（33／110），术后病理程度较术前病理轻占8．2％（9／110）。早期食管癌组术前活检与术后病理诊断符合率75．0％（18／24），高于上皮内瘤变组符合率58．1％（50／86），差异有统计学意义（P〈0．05）。结论术前活检病理与术后切除病理存在一定差异，术前病理对诊断有较好的提示价值，但不能完全代表病变性质，对于上皮内瘤变应结合临床经验，积极给予ESD治疗，获得准确诊断的同时对病灶进行处理。Objective To compare the similarities and differences between the esophageal mucosa lesion pathology before and after endoscopic submucosal dissection （ESD）. Methods A total of 110 patients diagnosed as having esophageal mucosal lesions by endoscopic biopsy were treated with ESD at Zhejiang cancer hospital from 2013 to 2014. The results of preoperative and postoperative pathology were compared. Results The consistency rate of preoperative biopsy and postoperative pathologic diagnosis was 61.8% （68/110）. Compared with preoperative pathology, the postoperative pathological results underestimated accounted for 30% （33/110）, the postoperative pathological results overestimated accounted for 8. 2% （9/110）. In early esophageal cancer group, consistency rate of preoperative biopsy and postoperative pathologic diagnosis was 75. 0% （18/24）, which was higher than that of intraepithelial neoplasia group [ 58. 1% （50/86）] with significant difference （ P 〈 0. 05 ）. Conclusion Preoperative biopsy is not necessarily consistent with postoperative pathology. Though preoperative pathological diagnosis has certain value, it can not completely represent the nature of the lesions. The patients with intraepithelial neoplasia should be actively treated with ESD combined with clinical experiences to get the accurate diagnosis.

关 键 词：早期食管癌 活组织检查 内镜黏膜下剥离术 病理 上皮内瘤变 

分 类 号：R735.1[医药卫生—肿瘤]