肠镜活检方式对直肠癌术前病理组织学分级准确率的影响

Effect of colonoscopy biopsy way on preoperative histopathology grading accuracy assessment of rectal adenocarcinoma

目的探讨一种能提高直肠癌术前病理组织学分级准确性的肠镜活检方式。方法对2010年1月～2011年6月该院肠镜活检确诊直肠癌并行手术治疗的108例患者随机分成实验组(56例)及对照组(52例),实验组采用内镜圈套器取材;对照组采用内镜活检钳取材,以术后大体病理切片组织学分级为标准,比较两种取材方式的活检切片病理组织学分级的准确率。结果内镜活检钳取材组术前病理组织学分级准确率为67.3%,术前活检分级偏低的病例占25.0%,分级偏高的病例占7.7%。圈套器取材组准确率为89.3%(P<0.01),术前活检分级偏低的病例占3.6%,分级偏高的病例占7.1%。两组活检取材方式均无直肠穿孔及大出血并发症发生。结论采用内镜圈套器对直肠癌术前病理活检取材,能提高术前病理活检组织学分级的准确性,是一种安全、理想的活检方式。

[Objective] To investigate a colonoscopy biopsy way of improving rectal cancer preoperative histopathology grading accuracy.[Methods] 108 patients diagnosed as rectal cancer by colonoscopy biopsy and underwent operation in Foshan Second People＇s Hospital from January 2010 to June 2011.108 patients were randomly divided into experimental group（56 cases） and control group（52 cases）.Endoscope snare was used for biopsy in experimental group and endoscope biopsy forceps in control group.The results of preoperative biopsy were compared to those of postoperative specimen considered as final diagnosis.The accuracy of preoperative assessment of histological grading was calculated.The accuracy rate between the two ways in histopathology grading were compared.[Results] Preoperative histopathology grading accuracy rate was 67.8% in control group,with 25% undergrading and 7.7% overgrading,while the histopathology grading accuracy rate was 89.3% in experimental group,with 3.6% undergrading and 7.1% overgrading（P 0.01）.Rectal perforation and massive haemorrhage didn＇t occur in two groups.[Conclusion] The endoscope snare biopsy way could improve rectal cancer preoperative histopathology grading accuracy rate.It is a safe and feasible biopsy way.