胃黏膜活检高度上皮内瘤变的手术病理对比研究

Comparison between biopsy-confirmed high grade intraepithelial neoplasia of gastric mucosa and corresponding surgical results

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 biopsy-diagnosed high grade intraepithelial neoplasia（HGIEN） of gastric mucosa with the corresponding surgical results. Methods Surgeries were performed on thirty-eight patients with biopsy-confirmed HGIEN of gastric mucosa. The morphology of lesions under endoscopy, tissue quantities of each procedure, features of the surgically removed specimens and their histopathological findings were investigated. Results Among the thirtyeight cases, HGIEN was confirmed in six cases（15.8 %）, adenocarcinomas were documented for the rest of 32 patients（84. 2%）, including 14 cases（36. 8%） of early gastric cancer and 18 cases（47. 4%） of advanced cancer. In a total of 21 patients with superficial lesions, surgical histopathological findings revealed that thirteen（61.9%） cases had early gastric cancer, two cases（9.5%） had advanced gastric cancer, only six cases were HGIEN. All surgical confirmed HGIEN lesions were superficial and similar to benign or marginal changes, with elevated/flat lesions not exceeding 20 mm and the depressed lesions not exce-eding 12 mm. Conclusions Patients with biopsy dignosed HGIEN of the stomach rnucosa have a high possibility of cancer coexistence, thus positive follow-up and appropriate surgical interventions are recommended to avoid misdiagnosis.