蓝激光内镜联合内镜黏膜下剥离术对“低级别上皮内瘤变”的诊治价值

Diagnostic and therapeutic value of blue laser endoscopy combined with endoscopic submucosal dissection for low grade intraepithelial neoplasia

目的评价蓝激光（BLI）放大染色内镜联合内镜黏膜下剥离术（ESD）对普通胃镜活检提示“低级别上皮内瘤变”的诊治价值。方法2014年1月至2016年1月，武汉大学人民医院普通胃镜活检提示“低级别上皮内瘤变”，术后3个月行BLI内镜复查发现病灶未愈合甚至有加重趋势，且接受ESD治疗的76例患者纳入回顾性研究，统计ESD的治疗效果和并发症发生情况，以及普通胃镜活检、BLI放大染色内镜分型与ESD术后全瘤病理诊断的符合率。结果ESD一次性完整切除率和治愈性切除率分别为100．0％（76／76）和97．4％（74／76），术中出血和穿孔发生率分别为3．9％（3／76）和1．3％（1／76），无迟发性出血和穿孔。普通胃镜活检、BLI放大染色内镜分型与ESD术后全瘤病理诊断的符合率分别为55．3％（42／76）和92．1％（70／76），差异有统计学意义（x2=51．987，P〈0．001）。结论上消化道低级别上皮内瘤变易被普通内镜活检低估，针对这部分被低估为“低级别上皮内瘤变”的病灶，ESD可用于明确诊断，同时还能给予安全有效的治疗，术前推荐行BLI放大染色内镜检查，病变的BLI分型对ESD切除上消化道黏膜病变有良好的提示作用。

Objective To evaluate the blue laser imaging （BLI） magnifying endoscopy combined with endoscopic submucosal dissection （ESD） in diagnosis and treatment of low grade intraepithelial neoplasia detected by normal endoscopic biopsy. Methods A total of 76 patients were diagnosed as having LGIN by preoperative biopsy. But 3 months later, BLI endoscopic reexamination showed that the lesions did not heal or even worsened. Patients who received ESD therapy were included in the retrospective study during January 2014 to January 2016 in Remin Hospital of Wuhan University. The efficacy and complications of ESD, and the consistence rate of diagnosis between general endoscopic biopsy, BLI magnifying endoscopy and pathologic diagnosis of total tumor after ESD were analyzed. Results The complete resection rate and curative rate of ESD were 100. 0% （ 76/76 ） and 97.4% （ 74/76 ） respectively. The incidences of hemorrhage and perforation during the operation were 3.9% （3/76） and 1.3% （1/76）, ＇and there was no delayed bleeding or perforation. The consistence rates of diagnosis of common endoscopic biopsy and BLI were 55.3% （42/76） and 92. 1% （70/76） respectively, with significant difference （X2= 51.987, P〈 0. 001）. Conclusion Low-grade intraepithelial neoplasia of the upper digestive tract may be easily underestimated by ordinary endoscopy biopsy. For these underestimated ＂low-grade intraepithelial neoplasia＂ lesions, ESD can not only be used to confirm the diagnosis, but also give safe and effective treatment. The examination of BLI combined with magnifying endoscopy is recommended before ESD, because BLI endoscopy classification of the lesions has positive effects on ESD of upper gastrointestinal mucosa lesions.