贲门黏膜病变患者内镜黏膜下剥离术前的内镜诊断与术后病理结果比较  

Comparison of endoscopic diagnosis before endoscopic submucosal dissection and postoperative pathological results in patients with gastric cardial mucosal lesions

作　　者：刘真真 张开光[1] 张明黎[1] 王业涛[1] 宋继中[1] 陈思[1] LIU Zhen-zhen;ZHANG Kai-guang;ZHANG Ming-li;WANG Ye-tao;SONG Ji-zhong;CHEN Si(Gastroenterology Department,Provincial Hospital Affiliated to Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽医科大学附属安徽省立医院消化内科,安徽合肥230001

出　　处：《临床医学研究与实践》2020年第10期102-105,共4页Clinical Research and Practice

摘　　要：目的探讨内镜黏膜下剥离术(ESD)前内镜诊断对贲门黏膜病变的临床价值。方法选择2015年1月至2019年6月在安徽省立医院内镜中心行ESD治疗的113例贲门黏膜病变患者为研究对象,患者术前给予胃镜病理活检、超声内镜检查及放大内镜检查,短期内均行ESD,以术后病理诊断结果为金标准,评价胃镜活检、超声内镜、放大内镜诊断效果及其与ESD术后病理诊断结果的一致性。结果术前胃镜活检的诊断准确率为46.9%,LGIN、HGIN和ECC的诊断准确率分别为36.0%、45.8%、68.8%,Kappa值为0.175。术前超声内镜诊断贲门黏膜病变浸润深度的准确率为73.5%,诊断黏膜内层和黏膜下层病变的准确率分别为95.0%和21.2%,Kappa值为0.202。术前放大内镜判断病变良恶性的准确率为64.6%,判断非癌性和癌性病变的准确率分别为81.1%和56.6%,Kappa值为0.319。术前超声内镜联合放大内镜诊断的准确率为55.8%,对上皮内瘤变、黏膜内癌和黏膜下癌的诊断准确率分别为81.1%、53.1%和25.9%,Kappa值为0.313。结论胃镜活检病理诊断贲门黏膜病变的可靠性欠佳,术前超声内镜联合放大内镜可以提高诊断的准确率。Objective To explore the clinical value of endoscopic diagnosis before endoscopic submucosal dissection(ESD)in gastric cardial mucosal lesions.Methods From January 2015 to June 2019,113 patients with gastric cardia mucosal lesions who underwent ESD treatment in the endoscopy center of Anhui provincial hospital were selected as the study objects.The patients were given gastroscopic biopsy,ultrasound endoscopy and magnifying endoscopy before operation,and were given ESD in a short time.The postoperative pathological diagnosis were used as gold standard,the diagnostic effects of gastroscopy biopsy,ultrasound endoscopy and magnifying endoscopy were evaluated,and the consistence with the pathological diagnosis result of ESD were evaluated.Results The diagnostic accuracy of preoperative gastroscopy biopsy was 46.9%,the diagnostic accuracy in LGIN,HGIN and ECC were 36.0%,45.8%,68.8%respectively,the Kappa value was 0.175.The accuracy of preoperative ultrasound endoscopy in the diagnosis of the depth of invasion of gastric cardial mucosal lesions was 73.5%,the accuracy of the diagnosis of intramucosal and submucosal lesions was 95.0%and 21.2%respectively,the Kappa value was 0.202.The accuracy of preoperative magnifying endoscopy in the diagnosis of benign and malignant lesions was 64.6%,the accuracy of the diagnosis of non-cancerous and cancerous lesions was 81.1%and 56.6%respectively,the Kappa value was 0.319.The diagnostic accuracy of preoperative ultrasound endoscopy combined with magnifying endoscopy was 55.8%,the accuracy of diagnosis of intraepithelial neoplasia,intramucosal cancer and submucosal cancer was 81.1%,53.1%and 25.9%respectively,the Kappa value was 0.313.Conclusion The gastroscopic biopsy in the diagnosis of gastric cardia mucosa lesions has poorreliability,preoperative ultrasound endoscopy combined with magnifying endoscopy can improve the accuracy of diagnosis.

关 键 词：贲门上皮内瘤变 早期贲门癌 超声内镜 放大内镜 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]