胃镜活检高级别上皮内瘤变术后病理升级的危险因素分析  

Risk factors of postoperative pathological upgrading in gastric high-grade intraepithelial neoplasia

作　　者：王涛[1] 李伟[1] 尹玉平 张鹏[1] 刘炜圳 胡鹏 高金波[1] 帅晓明[1] 王国斌[1] 陶凯雄[1] Wang Tao;Li Wei;Yin Yuping;Zhang Peng;Liu Weizhen;Hu Peng;Gao Jinbo;Shuai Xiaoming;Wang Guobin;Tao Kaixiong(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022

出　　处：《国际外科学杂志》2019年第12期810-814,F0003,共6页International Journal of Surgery

基　　金：国家自然科学基金(81702386,81874184);中央高校基本科研业务费专项资金资助(2017KFYXJJ230,2017KFYXJJ256)。

摘　　要：目的分析比较胃镜活检诊断胃高级别上皮内瘤变与术后病理诊断的一致性,探讨活检漏诊浸润癌的相关危险因素。方法回顾性分析2012年1月—2018年12月于华中科技大学同济医学院附属协和医院胃肠外科活检诊断为胃高级别上皮内瘤变且行完整切除的63例患者的病例资料,其中男性55例,女性8例;中位年龄60岁,范围为35~76岁。观察性别、年龄、内镜下病灶形态及最长径、CT检查及炎症指标等与术后病理升级的相关性。应用受试者工作特征曲线分析计量资料的诊断界限值,计数资料用χ^2检验或Fisher确切概率法。单因素分析筛选潜在的危险因素纳入多因素logistic回归分析,分析术后病理升级的独立危险因素。结果本研究共纳入63例患者,其中47例行外科手术切除,16例行内镜下黏膜剥离术切除。术后有44例(69.8%)经病理证实为浸润癌,19例(30.2%)维持高级别上皮内瘤变诊断。11例(17.5%)术前增强CT示病灶周围脂肪间隙浑浊者术后均证实为浸润癌。单因素分析,提示胃镜下肿瘤最长径≥2 cm(P=0.002)、病灶溃疡(P=0.013)、血小板淋巴比≥103(P=0.030)、CT示病灶周围淋巴结肿大(P=0.046)和脂肪间隙浑浊(P=0.025)组间差异存在统计学意义,多因素Logistic回归分析提示,胃镜下肿瘤最长径≥2 cm(P=0.033)和病灶溃疡(P=0.007)是预测术后病理升级的独立危险因素。结论胃镜活检诊断胃高级别上皮内瘤变与术后病理诊断一致性差。临床医师对胃镜活检诊断为胃高级别上皮内瘤变的患者,特别是增强CT示病灶周围脂肪间隙浑浊、胃镜下肿瘤最长径≥2 cm和病灶溃疡的病例应采取积极的外科干预。Objective To analyze the consistency of gastroscopic biopsy in the diagnosis of high grade intraepithelial neoplasia(HGIN)and postoperative pathological diagnosis,and explore the risk factors associated with missed diagnosis of HGIN.Methods From January 2012 to December 2018,the clinical data of 63 patients who were diagnosed with HGIN by gastroscopic biopsy prior to operation and underwent complete resection in the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.There were 55 males and 8 females,with a median age of 60(35 to 76)years old.The gender,age,endoscopic lesion shape,longest diameter,CT image and inflammatory markers were analyzed,to investigate the correlation between them and pathological upgrading after operation.Receiver operating characteristic(ROC)curve was drawn to analyze the cut off value of measurement data,and the comparison of count data was performed by chi-square test or Fisher exact probability method.Univariate analysis was used to screen potential risk factors,and multivariate logistic regression analysis was futher utilized to analyze the independent risk factors of postoperative pathological upgrading.Results A total of 63 patients were enrolled,including 47 cases underwent surgical resection and 16 cases underwent endoscopic submucosal dissection(ESD).Among them,19 patients(30.2%)were pathologically diagnosed with HGIN,while 44 patients(69.8%)were pathologically diagnosed with invasive cancer after resection.Preoperative contrast-enhanced CT showed that 11 patients(17.5%)with perigastric fat spiculation around the lesion,all of which were confirmed as invasive carcinoma after operation.Univariate analysis showed that the longest diameter of the lesion≥2 cm(P=0.002),ulcer lesions under gastroscopy(P=0.013),platelet to lymphocyte ratio(PLR)≥103(P=0.030),lymph node enlargement(P=0.046)and spiculation of the perigastric fat(P=0.025)were significant differences between the groups.Logistic regression analysis showed that

关 键 词：胃肿瘤 活组织检查 外科手术 

分 类 号：R73[医药卫生—肿瘤]