早期胃癌内镜粘膜下剥离术前评估

Pre-ESD evaluation in early gastric cancer

目的回顾性分析早期胃癌及癌前病变的内镜粘膜下剥离术(ESD)术前内镜下对病变大小、性质、深度的评估,确定病变是否能完整切除,减少ESD术后追加外科手术的风险。方法纳入2016年1月至2019年12月于河北省人民医院ESD治疗的75例胃粘膜高级别上皮内瘤变、早期胃癌患者为研究对象,根据病变白光内镜下表现、放大内镜、窄带成像内镜下特点、术前病理等对病变进行术前评估,以术后病理的病变大小、切缘阳性、病变深度、脉管浸润情况为标准。结果75例患者共79处病变,术前术后病理符合率分别为LGIN 100.00%(4/4),HGIN 97.83%处(45/46),腺癌89.66%(26/29),3种病变术前病理评估与术后病理一致率比较无统计学意义(χ^2=0.458,P=0.795)。病变类型及恶性程度与病变部位、大小无关,放大内镜联合窄带成像观察,高级别上皮内瘤变及早期胃癌内镜下特征表现为清楚的边界、不规则微血管、不规则表面微结构。病变>3cm,表面溃疡及自发性出血均可能是病变较深的危险因素。结论ESD既是治疗早期胃癌及癌前病变的手段,也是明确病理诊断的重要方法;术前精准评估病变类型、病变范围、浸润深度有利于提高ESD的完整切除率,减少追加外科手术的风险。

Objective Comparative analysis of the pathological diagnosis of endoscopic gastric biopsy and endoscopic submucosal dissection in patients with early gastric cancer and precancerous lesions in our hospital.Evaluate the size,nature and depth of the lesions before ESD,to reduce the risk of additional surgery after ESD.Methods From January 2016 to December 2019,the 75 patients with gastric mucosal HGIN,severe atypical hyperplasia and in situ carcinoma which were treated by ESD were include.The relationship between lesion area,expression of white light endoscopy,magnification endoscopy,narrowband imaging endoscopy and postoperative pathological classification and depth of lesion was analyzed.Results There were 75 patients with a total of 79 lesions.The coincidence rate of preoperative and postoperative pathology was LGIN 100.00%(4/4),HGIN 97.83%(45/46),Adenocarcinoma 89.66%(26/29).There was no significant difference between preoperative and postoperative pathological evaluation(χ^2=0.458,P=0.795).The type of lesion and the degree of malignancy were independent with the location and size of the lesion.The endoscopic features of high grade intraepithelial neoplasia and early gastric cancer were clear border,irregular microvessel and irregular surface microstructure.Lesions>3 cm,surface ulcer,spontaneous bleeding may be the risk factors for deeper lesions.Conclusion 1.Endoscopic submucosal dissection is not only a means for the treatment of early gastric cancer and precancerous lesions,but also an important method for clear pathological diagnosis.2.Magnification endoscopy combined with NBI can find early detection of HGIN and early gastric cancer.Preoperative biopsy had guidance significance in diagnosis and treatment,which can reduce the missed diagnosis of early gastric cancer.