胃黏膜高级别上皮内瘤变与癌变患者病灶内镜下特点及漏诊因素分析

Correlative factors of endoscopic features and missed diagnosis factors of high grade intraepithelial neoplasia and canceration in gastric mucosa

目的 比较胃黏膜高级别上皮内瘤变与癌变患者病灶内镜下特点，分析漏诊的相关因素。方法 90例行内镜黏膜下剥离术的胃黏膜高级别上皮内瘤变患者，分为高级别上皮内瘤变组（52例）与癌变组（38例），比较两组患者病灶内镜下特点及漏诊的相关因素。结果 两组患者病灶外观、病变位置、病灶表面黏膜结节及活检组织数量比较差异均未见统计学意义（P均〉0.05），而两组病变直径、病灶表面黏膜溃疡及病灶表面黏膜充血比较差异有统计学意义（P均〈0.05）。Logistic回归分析结果显示病灶〉20 mm（OR＝2.54，95% CI：1.21～5.98，P＝0.00）与病灶表面黏膜溃疡（OR＝4.12，95% CI：1.54～10.32，P＝0.00）是胃黏膜高级别上皮内瘤变容易发生漏诊癌变的独立危险因素。结论 临床中针对胃黏膜高级别上皮内瘤变患者其病灶〉20 mm或病灶表面出现黏膜溃疡时，应加强活检，减少对癌变的漏诊。

Objective To compare the endoscopic features of high-grade intraepithelial neoplasia and canceration in gastric mucosa, analyze the missed diagnosis factors.Methods Ninety cases of gastric high-grade neoplasia underwent endoscopic submucosal dissection were divided into high-grade neoplasia group with 52 cases and cancer group with 38 cases, and the different characteristics of endoscopic features and related factors of missed diagnosis were analyzed.Results The lesion morphology, lesion location, mucosal nodular lesion surface and biopsy times showed no significant difference between the two groups （P all〉0.05）, but the lesion size, mucosal ulceration and mucosal hyperemia of lesion surface showed significant difference between the two groups （P all〈0.05）. Logistic regression analysis results showed that lesions 〉20 mm （OR=2.54, 95%CI： 1.21-5.98, P=0.00） and mucosal ulceration of lesion surface （OR=4.12, 95%CI： 1.54-10.32, P=0.00） were an independent risk factor for the occurrence of misdiagnosis and canceration of gastric mucosa in advanced epithelial neoplasia.Conclusions In clinics, for the patients with advanced gastric mucosa lesions 〉20 mm or lesions on the surface of mucosal ulcer, should be strengthened biopsy, reduce missed diagnosis for cancer.