胃黏膜低级别上皮内瘤变内镜黏膜下剥离术后病理出现升级的危险因素  

Risk factors of pathological upgrading in gastric mucosa lesions with low-grade intraepithelial neoplasia afterendoscopic submucosal dissedion

作　　者：於亮亮[1] 吴加国[1] 刘启芳 戴宁[1] 姒健敏[1] Yu Liangliang Wu Jiaguo Liu Qifang Dai Ning Si Jianmin(Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China ,)

机构地区：[1]浙江大学附属邵逸夫医院消化内科,杭州310016 [2]浙江大学附属邵逸夫医院内镜中心,杭州310016

出　　处：《中华消化杂志》2017年第9期598-601,共4页Chinese Journal of Digestion

基　　金：浙江省医药卫生科技项目（2016KYB142）

摘　　要：目的探讨病理活组织检查提示胃黏膜低级别上皮内瘤变（LGIN）在内镜黏膜下剥离术（ESD）后病理出现升级的危险因素。方法回顾性分析2010年1月至2016年12月ESD术前病理活组织检查诊断为胃黏膜LGIN患者的完整病例资料，采用单因素方差分析和多因素Logistic回归分析ESD术后病理出现升级的危险因素。结果共纳入326例ESD术前病理活组织检查诊断为胃黏膜LGIN的患者，其中244例（74.85%）术后病理仍提示LGIN，82例（25.15%）术后病理出现升级，其中升级至高级别上皮内瘤变（HGIN） 61例（18.71%），早癌21例（6.44%）。单因素和多因素分析结果均提示，病变范围≥2.0 cm、病变呈凹陷型、病变黏膜表面发红、病变表面黏膜溃疡，以及病变表面自发性出血均是ESD术后病理出现升级的危险因素（F＝5.37、6.44、4.56、7.56、7.78，P均〈0.01），OR值（95%CI）分别为4.086（2.035～10.786）、7.435（2.845～19.862）、3.205（1.535～8.541）、8.668（3.365～21.457）、7.056（2.732～18.355），患者年龄、性别、病变部位均不是其危险因素。结论胃黏膜LGIN在ESD术后出现病理升级的情况较为常见，应警惕具有高危因素的LGIN病变，针对这些病例临床处理应更积极。ObjectiveTo investigate the risk factors of pathological upgrading in gastric mucosal lesions with low-grade intraepithelial neoplasia （LGIN） after endoscopic submucosal dissection （ESD）.MethodsFrom January 2010 to December 2016, the complete clinical data of 326 patients pathologically diagnosed with gastric LGIN lesions before ESD were retrospectively analyzed. Single factor analysis of variance and multiple factor Logistic regression analysis were performed to analyze the risk factors of pathological upgrading after ESD.ResultsA total of 326 patients with gastric LGIN lesions diagnosed by preoperative biopsy before ESD were enrolled. Among them the postoperative pathological diagnosis of 244 cases （74.85%） were still LGIN, while the postoperative pathological diagnosis of 82 cases （25.15%） were upgraded, of which 61 cases （18.71%） were upgraded to high-grade intraepithelial neoplasia and 21 （6.44%） were upgraded to gastric early cancer. The results of single and multiple factor analysis indicated that lesion size≥2.0 cm, deep depressed-type, surface erythema, lesion mucosa with ulceration and lesions with spontaneous bleeding were the risk factors of pathological diagnosis upgrading after ESD （F=5.37, 6.44, 4.56, 7.56 and 7.78, respectively; all P〈0.01）, odds ratio （OR） value and 95% confidence interval （CI） were 4.086 （2.035 to 10.786）, 7.435 （2.845 to 19.862）, 3.205 （1.535 to 8.541）, 8.668 （3.365 to 21.457） and 7.056 （2.732 to 18.355）. The age, gender and location of the lesion were not the risk factors.ConclusionsPathological upgrading is common in gastric lesions with LGIN after ESD. The lesions with high risk factors should be alerted and treated more actively.

关 键 词：胃黏膜低级别上皮内瘤变 内镜黏膜下剥离术 病理升级 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]