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目的比较胃黏膜活组织检查提示高度上皮内瘤变患者的病灶形态及手术病理间的关系。方法对胃镜下胃黏膜活组织检查提示高度上皮内瘤变的38例患者行外科手术治疗,对患者内镜下病灶形态、活检数量、手术大体标本形态及病理学诊断结果进行比较。结果38例患者中仅6例(15.8%)经手术证实维持高度上皮内瘤变诊断。其余32例(84.2%)为胃癌,其中早期胃癌14例(36.8%),进展期胃癌18例(47.4%)。21例浅表病变患者中,6例(28.6%)手术亦证实为高度上皮内瘤变,13例(61.9%)为早期胃癌,2例(9.5%)为进展期癌。术后维持高度上皮内瘤变诊断的6例均形似良性或交界性浅表病灶,其中隆起型或平坦型病灶均小于20mm,浅表凹陷性病灶均小于12mm,质地较软,可随蠕动变形。结论胃镜下胃黏膜活组织检查为高度上皮内瘤变的患者存在胃癌的概率高,应积极随访复查甚至于术干预,避免延误诊断和治疗。
OBJECTIVE: To compare the morphological features of lesions and the pathology of patients with high intraepithelial neoplasia by gastric mucosa biopsy. Methods Thirty-eight patients with high intraepithelial neoplasia underwent gastroscopic biopsy of gastric mucosa underwent gastroscopic surgery. Surgical treatment was performed on the patients with endoscopic lesions, biopsy volume, gross morphology and pathological diagnosis. Results Of the 38 patients, only 6 (15.8%) were confirmed by surgery to maintain a high degree of intraepithelial neoplasia. The remaining 32 cases (84.2%) were gastric cancer, including 14 cases of early gastric cancer (36.8%) and 18 cases of advanced gastric cancer (47.4%). Of the 21 superficial lesions, 6 (28.6%) had high grade intraepithelial neoplasia, 13 (61.9%) had early gastric cancer, and 2 (9.5%) had advanced cancer. Six cases with benign or borderline superficial lesions were diagnosed after the operation to maintain a high degree of intraepithelial neoplasia, of which the lesions were all less than 20 mm in size and less than 12 mm in superficial pitting lesions. The texture was soft and could vary with peristaltic deformation . Conclusion Gastric endoscopy gastric biopsy is a high degree of intraepithelial neoplasia in patients with high probability of gastric cancer should be followed-up or positive follow-up or even surgery intervention to avoid the delay diagnosis and treatment.