430例上消化道早期癌及癌前病变ESD术前活检与术后病理差异性分析  

Comparison of endoscopic submucosal dissection preoperative biopsy and postoperative pathology in 430 patients with early carcinoma and precancerous lesions of upper digestive tract

作　　者：郑家垚 许炎钦 林旭[1] 郑晓玲[1] 钟世顺[1] 邓万银[1] 郑金辉[1] 梁玮[1] ZHENG Jiayao;XU Yanqin;LIN Xu;ZHENG Xiaoling;ZHONG Shishun;DENG Wanyin;ZHENG Jinhui;LIANG Wei(Department of Gastrointestinal Endoscopy,Shengli Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院消化内镜中心,福建福州350001

出　　处：《胃肠病学和肝病学杂志》2020年第9期1026-1030,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：福建医科大学启航基金项目(2019QH1152)。

摘　　要：目的比较上消化道不同部位黏膜病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)术前胃镜活检病理与术后病理的差异。方法回顾性分析我院2018年1月至2019年9月因食管、胃黏膜病变行ESD治疗的患者共430例,比较不同部位(食管、贲门、胃体、胃角、胃窦)及有无静脉麻醉的胃镜活检病理与ESD术后病理结果准确性的差异。结果430例病灶中,食管206例,贲门93例,胃体40例,胃角40例,胃窦51例。胃镜术前活检病理与ESD术后病理诊断完全符合率为52.1%,ESD术后病理升级病灶为187例(43.5%),病理降级病灶为19例(4.4%)。各个部位符合率分别为58.3%、40.8%、52.5%、45.0%、52.9%,差异无统计学意义(P>0.05)。将ESD术前活检病理分类为轻判与非轻判两个组,单因素Logistic回归分析结果表明:较大面积的病灶术前活检轻判率增加差异有统计学意义(P<0.05),而对于病灶部位、形态、活检组织块数、有无静脉麻醉差异无统计学意义(P>0.05)。430例病灶中,术前活检由我院完成的有160例,其中麻醉胃镜97例,普通胃镜63例,麻醉胃镜与普通胃镜术前活检病理与ESD术后活检病理轻判率分别为38.1%(37/97)vs 52.4%(33/63),差异无统计学意义(P>0.05)。结论胃镜活检病理与ESD术后病理存在一定差异性,1/3以上的病灶有轻判的可能,故活检病理为癌前病变时应需进一步充分评估。上消化道各个部位的活检病理的准确性,差异无统计学意义。麻醉胃镜术前活检的轻判率低于普通胃镜,二者差异无统计学意义,但对于普通胃镜检查完成度不满意时,应建议麻醉胃镜下进一步评估。Objective To compare the difference of endoscopic submucosal dissection(ESD)preoperative biopsy and postoperative pathology in different parts of the upper digestive tract mucosal lesions.Methods A total of 430 patients who received ESD treatment for esophageal and gastric mucosal lesions in our hospital from Jan.2018 to Sep.2019 were retrospectively analyzed.And the accuracy of gastroscopy biopsy pathology of different parts(esophagus,cardiac,gastric body,gastric horn and gastric anuses)as well as those without intravenous anesthesia were compared with the pathological results after ESD.Results Among the 430 lesions,206 cases were esophageal lesions,93 cases were cardia lesions,40 cases were gastric body lesions,40 cases were gastric angle lesions,and 51 cases were gastric antrum lesions.The coincidence rate of pathology between preoperative biopsy and endoscopic submucosal dissection was 52.1%,while pathological upgrade after ESD was 187 lesions(43.5%)and degradation after ESD was 19 lesions(4.4%).The coincidence rate of pathology between preoperative biopsy and endoscopic submucosal dissection was not differed with different parts of upper digestive tract(58.3%,40.8%,52.5%,45.0%,52.9%).The results of univariate Logistic regression analysis were applied to preoperative biopsy pathology light sentence and non-light sentence groups.The results showed that there was statistical difference in the light sentence for preoperative biopsy of lesions with a larger area,while there was no statistical difference in lesion location,lesion morphology,number of biopsy pieces,and whether intravenous anesthesia.Among the 430 cases of lesions,160 cases were performed by our hospital for preoperative biopsy,including 97 cases of anesthesia gastroscopy and 63 cases of ordinary gastroscopy.The rate of underestimation of biopsy pathology by anesthesia gastroscopy and ordinary gastroscopy was 38.1%(37/97)vs 52.4%(33/63),respectively,with no statistical difference.Conclusion There is a certain difference between gastroscopy biopsy pa

关 键 词：上消化道 早期癌 活检病理 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]