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目的探讨胃高级别上皮内瘤变(HGIEN)在胃上皮性肿瘤性病变(GEN)诊断中的应用价值。方法参照WHO消化系统肿瘤分类(2000)标准,从胃镜活检病理诊断为HGIEN的病例中筛选出在本院行手术治疗的146例病理资料进行分析。结果 146例术后病理诊断:HGIEN25例(17.1%),T1(m)期36例(24.7%),T1(sm)期39例(26.7%),T2期22例(15.1%),T3期24例(16.4%),早期胃癌共100例(68.5%)。术后25例HGIEN主要分布:病变≤2cm19例、早期样病变24例和高分化癌25例。早期胃癌检出率较高的组别:远端胃78.8%(52/66)、病变≤2cm85.3%(64/75)、早期样病变88.6%(93/105例)和高分化癌71.6%(96/134)。进展期样病变组别中术后诊断为进展期癌的比率为82.9%(34/41例)。结论 HGIEN适用于高分化病变的诊断;应用于术前活检诊断对提高早期胃癌检出率具积极的临床意义。
Objective To investigate the value of HGIEN in the diagnosis of gastric epithelial neoplastic lesions (GEN). Methods According to WHO classification of tumor of the digestive system (2000), 146 cases of pathological data of surgical treatment in our hospital were screened out from the cases of HGIEN diagnosed by gastroscopic biopsy. Results Totally 146 cases were diagnosed by pathology. Twenty-five cases were diagnosed as HGIEN (17.1%), 36 cases (24.7%) with T1 (m) 24 cases (16.4%), 100 cases of early gastric cancer (68.5%). After operation, 25 cases of HGIEN were mainly distributed in 19 cases ≤2 cm, 24 cases of early-like lesions and 25 cases of well-differentiated carcinoma. 78.8% (52/66) of the distal stomach, lesions ≤ 2cm 85.3% (64/75), early lesions 88.6% (93/105 cases) and well-differentiated carcinoma 71.6 % (96/134). The rate of postoperative diagnosis of advanced cancer was 82.9% (34/41 cases) in the group of advanced disease. Conclusions HGIEN is suitable for the diagnosis of well-differentiated lesions. It has a positive clinical significance in preoperative biopsy to improve the detection rate of early gastric cancer.