从胃低级别上皮内瘤变切除标本看此类患者的处置原则

Investigate the treatment of patients with low-grade intraepithelial neoplasia from the clinical process and pathology

目的探讨胃低级别上皮内瘤变患者的一般处置原则。方法回顾性选择我院消化内镜中心2007年6月至2013年8月行EMR或ESD治疗且术前病理曾诊断为LIN患者的术前病理资料,病变时间,病变位置以及术后切除标本的病理资料,进行相关统计分析。结果共纳入病例151例,中位年龄60岁,男女比例为2.51∶1,50～80岁患者检出率最高。胃窦部病变检出率为51.66%,其次为胃角14.57%。术前共有30例患者末次病理提示为HIN,术后手术切除病变病理示8例为癌,64例HIN,58例LIN,其余为炎性病变,息肉等。结论应对50～80岁老年加强随访,活检时应注意远端胃的黏膜变化。此外,对于活检诊断LIN的患者,建议1～2周内于相同部位复取活检,排除HIN;发现LIN3个月以内患者均应复查病理。若复查病理仍为LIN,可继续观察,6个月后复查病理。若LIN持续存在,时间超过1年,可行内镜下干预治疗,以防止病变发展。

Objective Investigate the treatment of patients with low-grade intraepithelial neoplasia diagnosed by endoscopy and pathology. Methods This is a retrospective study which include patients underwent ESD or EMR while they had pathological diagnosis of low-grade intraepithelial neoplasia before operation between June 2007 and August 2013 in our department of gastroenterology. Analysis the data of pathology, clinical process and lesion location. Results Include 151 patients underwent ESD or EMR with diagnose of low-grade intraepithelial neoplasia to analysis. The detection rate in group of age 50 - 80 is highest. The most common detection location is gastric antrum. After operation, 8 lesions are cancer, 64 lesions are high-grade intraepithelial neoplasia, 58 lesions are low-grade intraepithelial neoplasia. Conclusions The patients who has pathological diagnose as low-grade intraepithelial neoplasia should have endoscopy and take biopsy in 1 - 2 weeks, even the patients whose process of low-grade intraepithelial neoplasia less than 3 months. If the recheck diagnosis is still low-grade intraepithelial neoplasia, patients could take examination after half year. The patients should undergo ESD or EMR in case of they have low-grade intraepithelial neoplasia last more than 1 year.