胃高级别上皮内瘤变新认识与正确处理

The new understanding and rational treatment about high-grade gastric intraepithelial neoplasia

近年来,胃高级别上皮内瘤变作为一个病理诊断已越来越多地应用于临床。实际上,这一概念应用之前曾经历了一系列的演变,其范畴逐步完善,但目前东西方专家对这一概念的理解却有较大的分歧,而临床医生和病理科医生也经常就这一术语争论不休。临床医生对胃上皮内瘤变的处理感到很困惑,到底选择内镜黏膜下剥离术(ESD)、腔镜治疗还是开放手术,目前尚无统一标准。外科医生和病理科医生的良好沟通,可能是目前处理上皮内瘤变的最佳方式;而癌前病变的研究和外科治疗,可能是今后肿瘤外科治疗的方向之一。

Recently, the high-grade gastric intraepithelial neoplasia, served as a pathological diagnosis, has been applied in the clinical practice more and more universally. Actually, a series of development have experienced prior to the concept and its category has gradually improved. However, major difference about understanding the concept has existed between the eastern and western experts, as well as between clinical and pathological doctors. Furthermore, clinical doctors feel so confused to treat gastric intraepithelia! neoplasia. By now, there is no uniform standard about how to choose endoscopic submucosal dissection （ESD）, laparoscopic surgery or open surgery. The harmonious communication between clinical and pathological doctors might be the optimal treatment for intraepithelial neoplasia. Moreover, the study of preca.ncerous lesions and surgical treatment might be one of the therapeutic tendencies about surgical oncology.