胃上皮内瘤变内镜活检与内镜下黏膜剥离术标本病理对比分析

目的：比较胃镜活检标本与内镜下黏膜剥离术（ESD）后标本病理结果间的关系。方法2013年8月至2015年8月接受ESD治疗的患者563例，将其中活检标本病理诊断为胃上皮内瘤变患者148例患者行回顾性分析，与ESD病理结果进行比较。结果148例胃上皮内瘤变患者镜下活检诊断低级别上皮内瘤变85例，ESD术后病理检查证实低级别上皮内瘤变55例，标本病理符合率64.71％（58/85）。镜下活检诊断高级别上皮内瘤变63例，ESD术后病理检查证实高级别上皮内瘤变45例，标本病理符合率71.43％（45/63）。其中低级别上皮内瘤变组25.88%的病理结果存在不同程度的升级现象，高级别上皮内瘤变组有14.29%（9/63）的病理结果存在升级现象。在胃上皮内瘤变的检出位置中，胃窦检出率最高，其次为胃体、胃角。结论胃上皮内瘤变ESD术后与胃镜活检病理结果相比存在升级现象，在临床中应结合胃镜形态特征与活检结果进行积极随访甚至内镜治疗，避免漏诊和误诊。

ObjectiveTo compare the results of endoscopic with endoscopic submucosal dissection（ESD）postoperative pathology. Method A total of 563 cases were be treated by ESD at endoscopy center of the First Affiliated Hospital to Zhejiang Chinese Medical University between 2013.8 and 2015.8,148 cases diagnosed by biopsy pathology as gastric intraepithelial neoplasia were retrospectively analyzed and compared with ESD pathological results.ResultOf the 148 cases,85 cases biopsy pathology was low-grade gastric intraepithelial neoplasia, and ESD postoperative pathology proved 55 cases was low-grade gastric intraepithelial neoplasia,its coincidence rate was 64.71%（58/85）. 63 cases biopsy pathology was high-grade gastric intraepithelial neoplasia,and ESD postoperative pathology proved 45 cases was high-grade gastric intraepithelial neoplasia,its coincidence rate was 71.43%（45/63）. 25.88%（22/85）pathological results showed that there were upgraded of different levels in low-grade gastric intraepithelial neoplasia group. 14.29%（9/63）pathological results showed that there were upgrade in high-grade gastric intraepithelial neoplasia group. The detection rate of gastric intraepithelial neoplasia was the highest in Gastric antrum,and the next was gastric body and gastric angle.Conclusion Gastric intraepithelial neoplasia diagnosed by endoscopic biopsy pathology has a high possibility of cancer coexistence,thus we should positively follow-up or appropriate endoscopic interventions by combining morphological characteristics with biopsy pathology to avoid misdiagnosis.