卢戈液染色与P53蛋白检测诊断早期食管癌和癌前病变

Iodine staining and P53 oncoprotein for the diagnosis of early esophageal cancer and precancerous lesion

目的探讨内镜下卢戈液染色和活检组织 P53检测诊断食管早期癌和癌前病变的可行性。方法 78例可疑早期食管癌患者行内镜下卢戈液染色，对粘膜不染色区活检结果为重度不典型增生细胞者行 P53蛋白免疫组化染色，对 P53蛋白阳性的病灶行内镜粘膜切除术。结果在 78例患者中，共发现 25例患者存在 31处粘膜不染色区，其中单纯增生上皮 1处，轻度异型增生 2处，中度异型增生 9处，重度异型增生 16处，鳞状细胞癌 3处。 7例 P53蛋白表达阳性的重度不典型增生粘膜行内镜粘膜切除术后， 1例被证实为粘膜内癌。结论卢戈液染色和活组织 P53蛋白检测不仅对诊断早期食管癌有帮助，而且对选择治疗重度不典型增生病灶行内镜粘膜切除术有指导意义。

Objective To explore the feasibility of Lugol's iodine staining in association with P53 oncoprotein test to detect early esophageal cancer and precancerous lesions through endoscopy. Methods Lugol's iodine was sprayed on esophageal mucosa under endoscopy in 78 patients with suspected early malignancy. Severe dysplasia which taken from unstained position by iodine were prepared immunohistochemically for P53 oncoprotein study. Then endoscopic mucosal resection (EMR) was performed to these severe dysplasia with P53 oncoprotein－ positive mucosa. Results There were 31 unstained areas (25 patients) including squamous cell carcinomas (n=3) and severe dysplasias (n=16). Expression of P53 was found in 7 severe dysplasia (43.8％ ),and 1 carcinoma in situ was found by EMR. Conclusion This modified method seemed feasible not only to detect early esophageal cancer,but also to resect severe dysplasia mucosa selectively by EMR.