胃高级别上皮内瘤变术后病理升级的危险因素分析  

Analysis of the risk factors of postoperative pathological progression in high-gradegastric intraepithelial neoplasia

作　　者：林楠[1] 林丽萍 黄新香 Lin Nan;Lin Liping;Huang Xinxiang(Department of gastroenterology,the affiliated hospital of Putian University,Putian,Fujian,351100,China)

机构地区：[1]莆田学院附属医院消化内科,福建莆田351100

出　　处：《齐齐哈尔医学院学报》2022年第15期1437-1440,共4页Journal of Qiqihar Medical University

基　　金：莆田市科技计划项目(2020S3F001)。

摘　　要：目的探讨胃高级别上皮内瘤变(HGIN)行内镜黏膜下剥离术(ESD)后病理升级的危险因素。方法回顾性分析2016年1月—2021年12月本院收治的68例胃镜活检结果为胃HGIN患者的临床资料。根据患者ESD术后病理分为胃癌组和胃HGIN组两组。收集入组患者年龄、性别、癌胚抗原(CEA)水平、内镜下表现(病灶大小、病灶部位、病灶类型、表面凹陷或溃疡)、幽门螺旋杆菌感染情况、内镜检查方式(普通或无痛)等信息。采用单因素和多因素Logistic回归分析影响胃HGIN行ESD术后病理升级的危险因素。结果68例患者中ESD术后共有30例(44.12%)维持胃高级别上皮内瘤变诊断,38例(55.88%)考虑癌变提示病理升级。单因素和多因素Logistic回归分析显示,病灶大小≥2 cm(P=0.008)、病灶表面凹陷或溃疡(P=0.022)是胃高级别上皮内瘤变术后病理升级的独立危险因素。结论对于具有病灶大小≥2 cm和病灶表面凹陷或溃疡特征的胃HGIN,临床医生需要注意可能会出现ESD术后病理升级的情况,应当综合评估后选择最佳的临床处理方案。Objective To investigate the risk factors of postoperative pathological progression in gastric high-grade intraepithelial neoplasia(HGIN)after endoscopic submucosal dissection(ESD).Methods A retrospective analysis was conducted on the clinical data of patients with gastric HGIN those were admitted to our hospital from January 1,2016 to December 31,2021.According to the pathology after ESD,patients were divided into the gastric cancer group and the gastric HGIN group.Information of age,gender,level of carcinoembryonic antigen(CEA),endoscopic manifestations(lesion size,lesion location,lesion type,surface depression or ulcer),Helicobacter pylori infection and endoscopic examination method(ordinary or painless)were collected.Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative pathological progression in gastric HGIN after ESD.Results Among the 68 patients,30 cases(44.12%)maintained the diagnosis of gastric HGIN after ESD,and 38 cases(55.88%)were considered canceration,suggesting pathological progression.Univariate and multivariate logistic regression analysis showed that lesion size≥2 cm(P=0.008)and lesion surface depression or ulceration(P=0.022)were independent risk factors of postoperative pathological progression in gastric HGIN.Conclusions For gastric HGIN with lesion size≥2 cm and lesion with surface depression or ulcer,clinicians should pay attention to the possibility of pathological progression after ESD and select the best clinical management plan after a comprehensive evaluation.

关 键 词：胃高级别上皮内瘤变 病理 危险因素 内镜粘膜下剥离术 

分 类 号：R735.2[医药卫生—肿瘤]