胃镜活检病理为高级别上皮内瘤变的外科精准治疗
| 作者: |
1,2苏昭然,
1王贤,
1,2束宽山,
1郑明,
1,2方志恒,
3邢益祥,
1王贵和
1 安徽省铜陵市人民医院胃肠外科，安徽 铜陵 244000 2 安徽省铜陵市人民医院内镜中心，安徽 铜陵 244000 3 安徽省铜陵市人民医院病理科，安徽 铜陵 244000 |
| 通讯: |
王贵和
Email: 19286541@qq.com |
| DOI: | 10.3978/.2018.04.003 |
| 基金: | 安徽省铜陵市卫计委2016年科研基金资助项目（卫科研[2016]30）。 |
摘要
目的：探讨胃黏膜病变活检病理诊断为高级别上皮内瘤变（HGIN）患者的外科治疗策略。
方法：回顾性分析2014年1月—2017年9月铜陵市人民医院胃肠外科收治的首次胃镜活检病理诊断为HGIN，且均接受根治性手术和/或内镜下治疗后取得完整病变组织学病理的70例患者的临床资料。
结果：全组患者中，7例（10.0%）术后病理维持HGIN的诊断，3例（4.3%）为低级别上皮内瘤变及黏膜慢性炎，1例（1.4%）为弥漫性大B细胞淋巴瘤，其余59例（84.3%）术后病理诊断为腺癌。单因素分析显示，年龄（P=0.029）、EUS评估黏膜下层侵犯可疑（P<0.001）、胃周淋巴结肿大（P=0.029）是术前诊断过低的重要危险因素。笔者团队制定了一个基于内镜下诊断、影像学评估和CEA血清水平等临床特征的决策树，以用于胃内病变活检病理诊断为HGIN的外科治疗方案选择。
结论：基于近年来内镜诊疗技术的进展，对于活检病理诊断为HGIN的胃黏膜病变患者，应遵循个体化外科精准治疗原则，避免过度治疗和治疗不足的发生。
关键词：
胃肿瘤/诊断；上皮内瘤样病变；决策树
方法：回顾性分析2014年1月—2017年9月铜陵市人民医院胃肠外科收治的首次胃镜活检病理诊断为HGIN，且均接受根治性手术和/或内镜下治疗后取得完整病变组织学病理的70例患者的临床资料。
结果：全组患者中，7例（10.0%）术后病理维持HGIN的诊断，3例（4.3%）为低级别上皮内瘤变及黏膜慢性炎，1例（1.4%）为弥漫性大B细胞淋巴瘤，其余59例（84.3%）术后病理诊断为腺癌。单因素分析显示，年龄（P=0.029）、EUS评估黏膜下层侵犯可疑（P<0.001）、胃周淋巴结肿大（P=0.029）是术前诊断过低的重要危险因素。笔者团队制定了一个基于内镜下诊断、影像学评估和CEA血清水平等临床特征的决策树，以用于胃内病变活检病理诊断为HGIN的外科治疗方案选择。
结论：基于近年来内镜诊疗技术的进展，对于活检病理诊断为HGIN的胃黏膜病变患者，应遵循个体化外科精准治疗原则，避免过度治疗和治疗不足的发生。
Precise surgical treatment strategies for patients with high-grade intraepithelial neoplasia of the stomach diagnosed by gastroscopic biopsy
CorrespondingAuthor:WANG Guihe Email: 19286541@qq.com
Abstract
Objective: To investigate the surgical treatment strategies for patients with gastric mucosal lesions diagnosed as high-grade intraepithelial neoplasia (HGIN) by gastroscopic biopsy.
Methods: The clinical data of 70 patients admitted in the Department of Gastrointestinal Surgery of Tongling People’s Hospital from January 2014 to September 2017 with initial diagnosis of HGIN made by gastroscopic biopsy and undergoing histopathological assessment of the whole lesion after radical resection and/or endoscopic treatment were retrospectively analyzed.
Results: In the whole group of cases, the postoperative pathological examination confirmed the diagnosis of HGIN in 7 cases (10.0%), while it revealed low grade intraepithelial neoplasia or chronic inflammation in 3 cases (4.3%), diffuse large B cell lymphoma in 1 case (1.4%) and adenocarcinoma in 59 cases (84.3%). Univariate analysis showed that age (P=0.029), suspicious submucosal invasion by EUS (P<0.001), and perigastric lymph node enlargement (P=0.029) were significant risk factors for very low preoperative diagnosis. The team of the authors based on the clinical factors such as endoscopic diagnosis, imaging evaluation and serum CEA level, developed a decision tree method for surgical treatment option of gastric lesions diagnosed as HGIN by biopsy.
Conclusion: Based on the development of endoscopic diagnosis and treatment technologies in recent years, the principle of individualized precise surgical treatment should be followed in patients with gastric mucosal lesions diagnosed as HGIN by biopsy, so as to avoid an over- or under-treatment.
Keywords：
Stomach Neoplasms/diag; Intraepithelial Neoplasia; Decision Trees
Methods: The clinical data of 70 patients admitted in the Department of Gastrointestinal Surgery of Tongling People’s Hospital from January 2014 to September 2017 with initial diagnosis of HGIN made by gastroscopic biopsy and undergoing histopathological assessment of the whole lesion after radical resection and/or endoscopic treatment were retrospectively analyzed.
Results: In the whole group of cases, the postoperative pathological examination confirmed the diagnosis of HGIN in 7 cases (10.0%), while it revealed low grade intraepithelial neoplasia or chronic inflammation in 3 cases (4.3%), diffuse large B cell lymphoma in 1 case (1.4%) and adenocarcinoma in 59 cases (84.3%). Univariate analysis showed that age (P=0.029), suspicious submucosal invasion by EUS (P<0.001), and perigastric lymph node enlargement (P=0.029) were significant risk factors for very low preoperative diagnosis. The team of the authors based on the clinical factors such as endoscopic diagnosis, imaging evaluation and serum CEA level, developed a decision tree method for surgical treatment option of gastric lesions diagnosed as HGIN by biopsy.
Conclusion: Based on the development of endoscopic diagnosis and treatment technologies in recent years, the principle of individualized precise surgical treatment should be followed in patients with gastric mucosal lesions diagnosed as HGIN by biopsy, so as to avoid an over- or under-treatment.