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中华胃肠内镜电子杂志 ›› 2019, Vol. 06 ›› Issue (03) : 97 -101. doi: 10.3877/cma.j.issn.2095-7157.2019.03.001

所属专题: 文献

论著

胃上皮内瘤变术前活检与内镜黏膜下剥离术后病理差异性的探讨
周骏1, 李杨1, 肖君1, 张其德1, 周玉宏1, 陈晶1, 张婷1, 金海林1, 韩树堂1,()   
  1. 1. 210029 南京,南京中医药大学附属医院(江苏省中医院)消化内镜中心
  • 收稿日期:2019-08-02 出版日期:2019-08-15
  • 通信作者: 韩树堂
  • 基金资助:
    2015年度国家中医临床研究基地业务建设第二批科研专项计划(JDZX2015086)

Discussion on pathological differences between preoperative biopsy and postoperative pathology of endoscopic submucosal dissection for gastric intraepithelial neoplasia

Jun Zhou1, Yang Li1, Jun Xiao1, Qide Zhang1, Yuhong Zhou1, Jin Chen1, Ting Zhang1, Hailing Jin1, Shutang Han1,()   

  1. 1. Digestive Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine(Jiangsu Provincial Hospital of Chinese Medicine), 210029 Nanjing, China
  • Received:2019-08-02 Published:2019-08-15
  • Corresponding author: Shutang Han
  • About author:
    Correspondingauthor: Han Shutang, Email:
引用本文:

周骏, 李杨, 肖君, 张其德, 周玉宏, 陈晶, 张婷, 金海林, 韩树堂. 胃上皮内瘤变术前活检与内镜黏膜下剥离术后病理差异性的探讨[J/OL]. 中华胃肠内镜电子杂志, 2019, 06(03): 97-101.

Jun Zhou, Yang Li, Jun Xiao, Qide Zhang, Yuhong Zhou, Jin Chen, Ting Zhang, Hailing Jin, Shutang Han. Discussion on pathological differences between preoperative biopsy and postoperative pathology of endoscopic submucosal dissection for gastric intraepithelial neoplasia[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2019, 06(03): 97-101.

目的

对胃黏膜上皮内瘤变术前活检与内镜黏膜下剥离术(ESD)后出现病理差异这一现象进行探讨,并分析导致这种差异的原因以及相关影响因素。

方法

回顾性分析了2016年7月至2019年6月经江苏省中医院住院行ESD治疗、术前活检为低级别上皮内瘤变(LGIN)/高级别上皮内瘤变(HGIN)的342例患者资料,运用统计学方法分析导致差异的影响因素。

结果

342例患者中,187例为LGIN、155例为HGIN。LGIN组中病理一致者占61.5%,升级为HGIN、早期胃癌及以上者分别为21.4%、12.8%,总升级率34.2%,降级为慢性炎症者4.3%。HGIN组病理维持一致者占40.6%,升级为早期胃癌及以上者占52.9%,降级为LGIN者6.5%。多因素回归分析结果显示:病灶位于胃上1/3、表面充血、结节、放大内镜下DL(+)、MV(+)是LGIN组病理升级的危险因素;病灶表面结节是HGIN病理升级的危险因素。

结论

白光内镜下活检与ESD后病理存在差异,病灶在胃上1/3、表面充血、结节、DL(+)、MV(+)是LGIN病理升级的危险因素;病灶表面结节是HGIN病理升级的危险因素。

Objective

To investigate the pathological differences between preoperative biopsy and postoperative pathology of ESDfor gastric mucosal intraepithelial neoplasia, and analyze the differences and related influencing factors.

Methods

This study retrospectively analyzed the data of 342 patients who received ESD treatment and were diagnosed as LGIN/HGIN by white light-gastroscopy biopsy in Jiangsu Provincial Hospital of Chinese Medicine from July 2016 to June 2019.Statistical methods were used to analyze the influencing factors leading to the difference.

Results

Among the 342 patients, 187 were diagnosed with LGIN, 155 were diagnosed with HGIN.In the LGIN group, 61.5% remain the same, 21.4% upgraded to HGIN and 12.8% upgraded to early or advanced gastric cancer. The total upgrade rate of LGIN was 34.2%, and the downgrade rate of chronic inflammation was 4.3%.In the HGIN group, 40.6% remain the same, 52.9%(82/155)upgraded to early or advenced gastric cancer, 6.5%(10/155)downgraded to LGIN. Results of multivariate regression analysis showed that lesions located in the upper 1/3 of the stomach, accompanied by surface hyperemia, surface nodule, DL(+ ), MV(+ )were risk factors for pathological upgrading in LGIN group.Surface nodule was the risk factor for pathological upgrading of HGIN.

Conclusions

There are differences between preoperative biopsy pathology under white light endoscopy and postoperative pathology, lesions in the upper 1/3 of the stomach, accompanied by surface hyperemia, surface nodular, DL(+ ), MV(+ )were the risk factors for pathological upgrading of LGIN group.Surface nodule was the risk factor for pathological upgrading of HGIN.

表1 342例患者内镜活检与内镜切除术后病理结果比较(例)
表2 LGIN组与HGIN内镜下特点的组间对比分析结果
表3 病理不变组与病理升级组间有差异的单因素比较结果
表4 病理不变组与病理升级组间有差异的多因素回归分析结果
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