内镜检查为胃高级别上皮内瘤变的诊治策略

Endoscopy as the diagnosis and treatment options for gastric high-grade intraepithelial neoplasia

目的:研究胃高级别上皮内瘤变的临床及病理特征,探讨外科治疗原则和策略。方法:回顾性分析37例术前经内镜活检诊断为高级别上皮内瘤变者临床资料,其中姑息手术2例,内镜下黏膜剥离术4例,根治性手术30例(全胃切除21例,远端胃切除9例),腹腔镜下探查1例,并将术后病理与术前病理作比较。结果:术后病理提示只有3例仍为高级别上皮内瘤变,1例为异性增生,余33例均为腺癌(淋巴结转移26例,7例无淋巴结转移)。结论:术前病理活检为胃高级别上皮内瘤变的病例与术后病理结果一致性较差,我们需结合病灶的部位﹑大小﹑内镜下的大体形态及临床分期,做出个体化﹑精准化﹑规范化的治疗。

Objective ：To investigate the clinical and pathological characteristics of gastric high-grade intraepithelial neoplasia for planning the surgical treatment options.Methods：Retrospective analysis was performed in 37 cases of gastric high-grade intraepithelial neoplasia diagnosed by preoperative en- doscopic biopsies. Of all patients, 2 received palliative surgery, 4 endoscopic mucosal stripping, 30 radical surgery（ total gastrectomy in 21, distal gastrectomy in 9） , and l laparoscopic exploration. Comparison was made between the pathological findings before and after surgery. Results：Postoperative pathology revealed high-grade intraepithelial neoplasia in only 3 patients, dysplasia in 1, and adenocarcinoma in the remaining 33 （ including lymph node metastasis in 26, and absence of lymph node metastasis in 7 ）. Conclusion ： Preoperatively confirmed as high-grade intraepithelial neoplasia by endoscopic biopsies can be inconsistent with the postoperative pathological findings, suggesting that such neoplasm should be diagnosed based on its lesion location, size, gross morphology under endoscopy and clinical staging for tailed, accurate and standard treatment.