电子胃镜活检病理诊断伴幽门螺杆菌感染的胃黏膜上皮内瘤变的分析

Retrospective analysis on advantages and disadvantages of gastric endoscopic biopsy on pathological diagnosing gastric lesions with helicobacter pylori infection

目的评价电子胃镜活检病理诊断伴幽门螺杆菌感染的胃黏膜上皮内瘤变价值。方法 99例电子胃镜活检诊断胃黏膜上皮内瘤变,均有外科手术病理对照,分析影响电子胃镜活检准确性的因素。结果诊断为胃浸润癌的病例术前电子胃镜活检病理诊断为LGIN与HGIN的比例分别为7.4%(7/94)及68.1%(64/94),两者有显著差异(P<0.05)。相符组与不相符组比较,内镜分型Ⅱ型、肿瘤大小>2cm、肿瘤高中分化,是诊断准确性降低的因素。轻-中度胃炎,符合率为37.0%(20/54),重度胃炎,符合率为17.8%(8/45),两者有显著差异(P<0.05)。结论电子胃镜病理活检可以发现绝大部分的胃部病变患者。一次活检不能排除胃癌的可能。电子胃镜活检病理诊断为高级别GIN时,大多数情况下有更重病变的可能,内镜分型Ⅱ型、肿瘤大小>2cm、肿瘤高中分化,胃炎越重,胃镜活检与随访及外科手术病理符合率越低,密切随访及外科手术治疗可以弥补电子胃镜活检病理诊断的不足,最大限度地提高胃部疾病诊断准确性。

Objective To evaluate the advantages and disadvantages of gastric endoscopic biopsy for the pathological diagnosis of gastric lesions with helicobacter pylori infection.Methods 99 cases received gastric endoscopic biopsy for the pathological diagnosis before surgical resection.The diagnose accordance rate of gastric endoscopic biopsy for the pathological and surgical resection were compared.Results Invasive gastric carcinoma existed in 7.4 ％ and 68.1％ of cases which had been diagnosed low-grade GIN and high-grade GIN on gastric endoscopic biopsy,respectively （P＜0.05）.Endoscopic type Ⅱ（P＜0.05） 、size of tumour more than 2 cm （P＜0.05）and higher tumor differentiation （P＜0.05） were found with reducing concordance rate of pathology.The concordance rate of mild and moderate gastritis was 37.0 ％ （20/54）,which was significantly higher than the concordance rate of marked gastritis1 7.8 ％ （8/45） P＜ 0.05）.Conclusion Gastric endoscopic biopsy for the pathological diagnosis could identify most gastric lesions,though invasive gastric carcinoma could not be excluded based on endoscopic biopsy only.When high-grade gastric lesions were identified by gastric endoscopic biopsy,endoscopic type Ⅱ、size of tumour more than 2 cm、higher tumor differentiation 、more marked gastritis are associated with the lower concordance rate of gastric endoscopic biopsy and regularly endoscopic examination、pathological diagnosis of surgical resection.Regularly endoscopic examination and surgical resection should be recommended to effectively make up for the disadvantages of gastric endoscopic biopsy and to improve the accuracy of diagnosis,for more severe lesions might exist in these cases.