内镜下黏膜下层剥离术治疗上消化道黏膜高级别上皮内瘤变的价值及术后病理分析  

Value of endoscopic submucosal dissection in the treatment of high-grade intraepithelial neoplasia in the upper gastrointestinal tract and postoperative pathological analysis

作　　者：刘鹏军[1] 葛亚强[1] 王晓燕 张利霞[1] 许丽娟[1] 徐敏 

机构地区：[1]江苏大学附属武进医院消化内科,江苏常州213002 [2]宿迁市第一人民医院消化科

出　　处：《胃肠病学和肝病学杂志》2015年第12期1433-1436,共4页Chinese Journal of Gastroenterology and Hepatology

基　　金：2014年武进区科技计划:武科发(2014)27号(WS201421)

摘　　要：目的探讨内镜下黏膜下层剥离术(endoscopic submucosal dissection,ESD)治疗上消化道黏膜高级别上皮内瘤变(highgrade intraepithelial neoplasia,HGIN)的临床疗效,并分析手术前后标本病理特点。方法 48例研究对象术前经胃镜活检标本检查确诊为黏膜HGIN,均经ESD治疗。观察手术时间、并发症、病灶大小、术后病理特点,评价整块切除率、完整切除率及治愈性切除率等指标。结果手术整块切除率100%,手术平均时间(76.8±23.4)min,1例穿孔。ESD切除标本最大直径(25.9±11.4)mm,术后病理证实维持HGIN 33例、HGIN伴局灶癌变11例、高-中分化腺癌3例、低级别上皮内瘤变(low-grade intraepithelial neoplasia,LGIN)1例,术前术后病理诊断符合率68.8%,与活检相比,ESD手术标本诊断HGIN更准确(χ2=17.778,P<0.05),HGIN癌变率29.2%,食管黏膜癌变率与胃黏膜癌变率比较差异无统计学意义(χ2=1.838,P>0.05);ESD术完整切除率95.8%,治愈性切除率95.8%。1例局部复发,2例食管ESD术后狭窄。结论上消化道黏膜HGIN具有潜在癌变风险,胃镜活检标本不能准确评估其性质,ESD可一次性完全切除病灶,且可以提供完整标本进行进一步病理学评估,值得临床推广。Objective To investigate the clinical curative effect of endoscopic submucosal dissection （ESD） in the treatment of high-grade intraepithelial neoplasia （HGIN） in the upper gastrointestinal tract, and analyze the pathological features of post-ESD specimen. Methods Forty-eight cases of HGIN in the upper gastrointestinal tract were detected by endoscopic forcep biopsy and treated with ESD procedure. The operation time, complication, vesion size and pathological feature of post-ESD were observed. The en bloc resection rate, complete resection rate and curative resection rate, etc were analyzed. Results The total en bloc resection rate was 100% , the complete and curative rescetion rates were 95.8% and 95.8%. The operation time was （76.8 ±23.4） min. The perforation rate was 2.1%. Post-ESD pathology confirmed 33 cases of HGIN, 11 cases of HGIN with focal cancerous, 3 cases of high-moderately differentiated adenocarcinoma and 1 case of LIGN. The diagnostic accordance rate was 68.8%. Compared with biospy, ESD was more accurate in diagnosis of HGIN （X^2 = 17. 778, P 〈 0.05）. The canceration rate of HGIN was 29.2% , and no statistical difference was found between esophageal canceration and gastric canceration （X^2 = 1. 838, P 〉 0.05）. During follow-up, local recurrence was found in 1 case, and esophageal stenosis after ESD was found in 2 cases. Conclusion ESD is an effective and safe method for resec- tion of HGIN in the upper gastrointestinal tract with little complications and low recurrence, which can also provide lager rescetion specimen for further pathological evaulation.

关 键 词：内镜下黏膜下层剥离术 高级别上皮内瘤变 上消化道 

分 类 号：R57[医药卫生—消化系统]