结直肠上皮内瘤变内镜切除前后病理观察对比分析  

Comparative analysis of pathological observation before and after endoscopic resection of colorectal intraepithelial neoplasia

作　　者：孟云超[1] 张启芳[1] MENG Yun-chao;ZHANG Qi-fang(Department of Gastroenterology, NanxishanHospital of Guangxi Zhuang Autonomous Region, Guilin 541002, China)

机构地区：[1]广西壮族自治区南溪山医院消化内科,541002

出　　处：《中国实用医药》2019年第12期16-17,共2页China Practical Medicine

基　　金：国家自然科学基金地区科学基金项目(项目编号:81560094);骨髓间充质干细胞对实验性结肠炎所致肝损伤的治疗作用机制;广西区南溪山医院院级课题(项目编号:NY2018005);DOK3;PTK7在结肠癌及癌前病变中的表达及意义

摘　　要：目的通过对结直肠内镜下黏膜切除术(EMR)/内镜下黏膜剥离术(ESD)获得的上皮内瘤变标本的病理学进行观察,探讨术前及术后病理诊断差异的原因及改善方法。方法回顾性分析60例结直肠上皮内瘤变患者EMR/ESD的标本资料以及术前活检病理资料,分析术前活检病理与EMR/ESD术后病理的诊断符合情况。结果术前、术后病理的诊断符合率为66.7%(40/60),术后病理诊断级别升高占30.0%(18/60),级别降低占3.3%(2/60),其中低级别上皮内瘤变诊断符合率为75.0%(24/32),级别升高占18.8%(6/32),级别降低占6.3%(2/32);高级别上皮内瘤变诊断符合率为57.1%(16/28),级别升高占42.9%(12/28),级别降低占0(0/28)。结论结直肠黏膜活检与EMR/ESD术后病理诊断符合率偏低,主要表现为术后级别升高,术前活检病理诊断不能完全代表结直肠黏膜病变的性质,处理不应局限于定期内镜随访或组织活检的病理信息,应结合内镜情况并积极行EMR/ESD治疗。Objective To discuss the causes of the difference in pathological diagnosis before and after operation and the improvement methods by observing the pathology of endoscopic mucosal resection(EMR)/endoscopic submucosal dissection(ESD) specimens of intraepithelial neoplasia. Methods The EMR/ESD specimens and preoperative biopsy pathological data of 60 patients with colorectal intraepithelial neoplasia were retrospectively analyzed. The diagnostic coincidence between preoperative biopsy pathology and postoperative pathology of EMR/ESD was analyzed. Results The diagnostic coincidence rate of pathology before and after operation was 66.7%(40/60). Postoperative pathological diagnosis grade increased by 30.0%(18/60) and decreased by 3.3%(2/60). The diagnostic accuracy of low grade intraepithelial neoplasia was 75.0%(24/32), with grade increased by 18.8%(6/32) and grade decreased by 6.3%(2/32). The diagnostic coincidence rate of high grade intraepithelial neoplasia was 57.1%(16/28), with grade increased by 42.9%(12/28) and grade decreased by0(0/28). Conclusion The coincidence rate between colorectal mucosal biopsy and pathological diagnosis after EMR/ESD is low. The main manifestation is that the level of pathological diagnosis increases after operation, and preoperative biopsy pathological diagnosis can not fully represent the nature of colorectal mucosal lesions. The treatment should not be limited to the pathological information of regular endoscopic follow-up or tissue biopsy.EMR/ESD treatment should be actively combined with endoscopic conditions.

关 键 词：结直肠肿瘤 上皮内瘤变 病理诊断 内镜下黏膜切除术 内镜下黏膜剥离术 

分 类 号：R735.34[医药卫生—肿瘤]