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目的 :对胃黏膜上皮性肿瘤术前活检准确性进行分析比较,以期更好的对内镜下微创治疗进行评估。方法 :收集南京医科大学第一附属医院2015年9月至2016年8月胃镜活检明确为胃黏膜上皮性肿瘤并及时行内镜下黏膜剥除术(endoscopic submucosal dissection,ESD)治疗患者共117例,对比分析术前活检病理结果的准确度。结果:ESD术后病理证实术前活检准确率为59.0%(69/117),其中术前黏膜低级别瘤变(mucosal low grade neoplasia,MLGN)准确率为64.4%(29/45),黏膜高级别瘤变(mucosal high grade neoplasia,MHGN)准确率为49.2%(31/63),黏膜下浸润癌(submucosal invasion by carcinoma,SIC)准确率为100%(9/9)。术前诊断MHGN者术后证实为SIC占42.9%(27/63)。术前病理严重程度低于ESD术后病理结果占36.8%(43/117),术前病理严重程度高于术后病理结果占4.1%(5/117)。术前诊断SIC准确率显著大于MHGN组(P<0.01)和MLGN组(P<0.01),而术前诊断MLGN组准确率显著高于术前诊断MHGN组(P<0.05),具有统计学差异。胃窦黏膜病变ESD术前病理准确率显著高于贲门或贲门下(P<0.01)和胃体(P<0.01),具有显著统计学差异。结论:胃黏膜病变内镜下活检对病情判断具有重要作用,但术前病理严重程度存在低于实际病变可能,尤其术前诊断胃黏膜高级别瘤变患者有一定比例已经癌变,因此结合内镜特征积极进行内镜手术治疗,对于防止延误病情、改善患者预后有重要意义。
Objective: To analyze and compare the accuracy of preoperative biopsy of gastric mucosal epithelial tumors in order to better evaluate the minimally invasive endoscopic treatment. METHODS: A total of 117 patients with gastric mucosal epithelial tumors and prompt endoscopic submucosal dissection (ESD) were collected from the First Affiliated Hospital of Nanjing Medical University from September 2015 to August 2016. , Comparative analysis of preoperative biopsy accuracy of the results. Results: The accuracy of preoperative biopsy was 59.0% (69/117). The accuracy of preoperative mucosal low grade neoplasia (MLGN) was 64.4% (29/45). The mucosal height The accuracy rate of MHC was 49.2% (31/63). The accuracy of submucosal invasion by carcinoma (SIC) was 100% (9/9). Preoperative diagnosis of MHGN were confirmed as SIC accounted for 42.9% (27/63). Preoperative histopathological severity was lower than that of ESD (36.8%, 43/117). Preoperative pathologic severity was higher than postoperative pathology (4.1%, 5/117). The accuracy of preoperative diagnosis of SIC was significantly higher than that of MHGN group (P <0.01) and MLGN group (P <0.01), while the accuracy of preoperative diagnosis of MLGN group was significantly higher than preoperative diagnosis of MHGN group (P <0.05) . The pathological accuracy of ESD before antral mucosal lesions was significantly higher than that under the cardia or cardia (P <0.01) and the corpus (P <0.01), with statistically significant differences. Conclusion: Endoscopic biopsy of gastric mucosal lesions plays an important role in judging the severity of the disease. However, the severity of preoperative pathological changes may be lower than the actual ones. In particular, a certain proportion of patients with high-grade neoplasms diagnosed by gastroscopy before operation are already cancerous. Therefore, Characteristics of active endoscopic surgical treatment for the prevention of delayed illness, improve patient prognosis of great significance.