摘要
目的评价术前活检在胃粘膜病变内镜粘膜下剥离术(ESD)治疗中的应用价值。方法对195例术前活检明确诊断为胃上皮内瘤变或早癌患者的临床资料进行回顾性总结,统计术前活检诊断与ESD术后病理诊断的差异性。结果术前活检与术后病理总符合率达93.8%(183/195),完全一致率为50.8%(99/195),其中低级别上皮内瘤变完全一致率为49.4%(42/85),高级别上皮内瘤变完全一致率为38.0%(30/79),早癌完全一致率为87.1%(27/31),早癌诊断一致率明显高于低级别上皮内瘤变和高级别上皮内瘤变(P<0.05),而低级别上皮内瘤变诊断一致率与高级别上皮内瘤变比较差异无统计学意义(P>0.05)。有66例(33.8%,66/195)术后病理较术前活检病理程度加重,其中低级别上皮内瘤变有36例(42.4%,36/85),高级别上皮内瘤变有30例(38.0%,30/79);有18例(9.2%,18/195)术后病理较术前活检病理程度减轻,其中高别上皮内瘤变有14例(17.7%,17/79),早癌有4例(12.9%,4/31);术后病理证实为炎性组织12例(6.2%,12/195),其中低级别上皮内瘤变有7例(8.2%,7/85),高级别上皮内瘤变有5例(6.3%,5/79)。结论术前活检病理结果不能完全代表胃粘膜病变的性质,但术前活检病理对ESD切除胃粘膜病变具有良好的提示作。
Objective Objective To evaluate the application value of preoperative biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection(ESD).Methods Clinical data of 195 patients who had been diagnosed with gastric intraepithelial neoplasia(GIEN) or early cancer by preoperative biopsy were retrospectively analyzed for statistical analysis of the discrepancy of pathological diagnosis between endoscopic biopsies and specimens after ESD.Results The total accordance rate of pathological diagnosis between preoperative biopsies and postoperative specimens was 93.8%(183/195)and the full consistency rate was 50.8%(99/195).Of low-grade gastric intraepithelial neoplasia(LGIEN),the full consistency rate was 49.4%(42/85),of high-grade gastric intraepithelial neoplasia(HGIEN) was 38.0%(30/79) and of early cancer was 87.1%(27/31).The full consistency rate was significantly higher in the early cancer group than in the LGIEN group or HGIEN group(P<0.05).There was no statistically significant differences between the full consistency rate of LGIEN group and HGIEN group(P>0.05).There were 66 patients(33.8%,66/195) whose pathological diagnosis after ESD were more severe than biopsy,including 36 cases of LGIEN(42.4%,36/85) and 30 cases of HGIEN(38.0%,30/79).There were 18 patients(9.2%,18/195) whose final pathological diagnosis were milder than biopsy,containing 14 cases of HGIEN(17.7%,14/79) and 4 cases of early cancer(12.9%,4/31).There were 12 patients(6.2%,12/195) who were diagnosed with gastritis by postoperative pathology,including 7 cases of LGIEN(8.2%,7/85) and 5 cases of HGIEN(6.3%,5/79).Conclusion The pathological diagnosis by preoperative biopsies is insufficient for representative of the nature of gastric mucosal lesions,but it has a role of good prompt for resection gastric mucosal lesions by ESD.
出处
《中国继续医学教育》
2011年第12期86-89,共4页
China Continuing Medical Education
关键词
上皮内瘤变
早癌
活检
内镜粘膜剥离术
病理
Intraepithelial neoplasia
Early cancer
Biopsy
Endoscopic submucosal dissection
Pathology
