胃黏膜病变术前活检病理和内镜黏膜下剥离术后病理诊断的比较  

Differential analysis of preoperative biopsy pathology and postoperative pathological diagnosis of endoscopic submucosal dissection in gastric mucosal lesions

作　　者：黄丽娜 陈朝元[1] 张虹 李玉龙 HUANG Lina;CHEN Chaoyuan;ZHANG Hong;LI Yulong(Department of Gastroenterology,People's Hospital Affliated to the Fujian University of Traditional Chinese Medicine,Fujian Province,Fuzhou 350004,China)

机构地区：[1]福建中医药大学附属人民医院消化内科,福建福州350004

出　　处：《中国当代医药》2024年第29期22-25,共4页China Modern Medicine

基　　金：福建省自然科学基金资助项目(2021J01899)。

摘　　要：目的探讨胃黏膜病变术前活检病理和内镜黏膜下剥离术(ESD)术后病理诊断的差异性及其危险因素。方法回顾性分析2021年6月至2023年12月福建中医药大学附属人民医院收治的115例胃黏膜病变患者的临床资料,术前均接受胃镜活检检查,并接受胃ESD,术中获取病变组织标本。比较患者术前活检病理和胃ESD术后病理诊断,采用logistic回归分析影响病理升级的危险因素。结果115例胃黏膜病变患者术前活检病理和ESD术后病理诊断一致者为59例(51.30%),其中慢性炎性改变一致率为34.38%(11/32),低级别上皮内瘤变一致率为67.31%(35/52),高级别上皮内瘤变一致率为33.33%(9/27),早期胃癌一致率为100.00%(4/4);术后病理降级率为8.70%(10/115),升级率为40.00%(46/115);单因素分析显示:不同年龄、性别、病变部位、颜色改变、糜烂及溃疡、黏膜结节感、大体形态者胃ESD术后病理升级比例比较,差异无统计学意义(P>0.05);不同病灶最大直径者胃ESD术后病理升级比例比较,差异有统计学意义(P<0.05)。logistic回归分析显示,病灶最大直径>2 cm(β=-0.972,OR=0.378,95%CI:0.172~0.831)是胃ESD术后病理升级的保护因素(P<0.05)。结论胃黏膜病变术前活检病理和ESD术后病理诊断存在一定差异性,其主要受病灶最大直径影响,临床需加以重视。Objective To explore the differences and risk factors in preoperative biopsy pathology and postoperative patho-logical diagnosis of gastric mucosal lesions after endoscopic submucosal dissection(ESD).Methods The clinical data of 115 patients with gastric mucosal lesions admitted to People's Hospital Affiliated to the Fujian University of Traditional Chi-nese Medicine from June 2021 to December 2023 were retrospectively analyzed.All patients underwent gastroscopy biopsy and gastric ESD before surgery,and the pathological tissue specimens were obtained during operation.The preoperative biopsy pathology and postoperative gastric ESD pathological diagnosis were compared,and the risk factors affecting patho-logical escalation were analyzed by logistic regression analysis.Results Among the 115 patients with gastric mucosal le-sions,59 cases(51.30%)had consistent preoperative biopsy pathology and ESD postoperative pathology diagnosis.The con-sistency rate of chronic inflammatory changes was 34.38%(11/32),the consistency rate of low-grade intraepithelial neopla-sia was 67.31%(35/52),the consistency rate of high-grade intraepithelial neoplasia was 33.33%(9/27),and the consistency rate of early gastric cancer was 100.00%(4/4).The postoperative pathological degradation rate was 8.70%(10/115),and the upgrade rate was 40.00%(46/115).Univariate analysis showed that there were no significant differences in the proportion of gastric ESD postoperative pathological upgrade among patients with different age,sex,lesion site,color change,erosion and ulcer,mucosal nodule sensation,and gross morphology(P>0.05).The proportion of gastric ESD postoperative pathological upgrade in patients with different lesion maximum diameter was statistically significant(P<0.05).Logistic regression analysis showed that the maximum lesion diameter>2 cm(β=-0.972,OR=0.378,95%CI:0.172-0.831)was a protective fac-tor for the pathological upgrading of gastric ESD surgery(P<0.05).Conclusion There is a certain difference between pre-operative biopsy pathology a

关 键 词：胃黏膜病变 内镜黏膜下剥离术 病理升级 早期胃癌 

分 类 号：R735.2[医药卫生—肿瘤]