摘要
目的探讨胃低级别上皮内瘤变(LGIN)内镜黏膜下剥离术(ESD)后病理升级的危险因素。方法回顾性分析2016年9月-2019年7月在宁波大学医学院附属阳明医院消化内镜中心活检病理诊断为LGIN的138处病灶,均行ESD治疗,按活检与ESD术后病理差异分为未升级组与升级组,采用单因素和多因素分析探讨ESD术后病理升级的危险因素。结果138处LGIN病灶,ESD术后66处(47.83%)发生病理升级,单因素分析结果提示:病灶大小≥2 cm及病灶形态凹陷与ESD术后病理升级相关(P<0.05)。多因素分析结果提示:病灶大小≥2 cm(OR=6.872,95%CI:2.197~21.499,P=0.002)是LGIN ESD术后病理升级的独立危险因素。结论活检不能完全反映LGIN病灶性质,当LGIN病灶大小≥2 cm时应注意存在病理升级可能,应积极行活检复查,甚至通过ESD或外科手术明确病灶性质。
Objective To discuss the risk factors of pathological upgraded of gastric low-grade intraepithelial neoplasia(LGIN)after endoscopic submucosal dissection(ESD).Methods 138 lesions biopsy pathologic diagnosed LGIN from September 2016 to July 2019 were retrospectively analyzed,they were all performed ESD treatment,according to biopsy and ESD postoperative pathological differences can be divided into not upgrade and upgrade group,using the single factor and multiple factors analysis to investigate the risk factors of ESD postoperative pathological upgrade.Results In 138 LGIN lesions,66 lesions(47.83%)pathological upgrading occurred after ESD,the results of single-factor analysis suggested that the lesion size≥2 cm and the morphological depression of the lesion were correlated with the pathological upgrading after ESD(P﹤0.05).The results of multivariate analysis suggested that the lesion size≥2 cm(OR=6.872,95%CI:2.197~21.499,P=0.002)was an independent risk factor for the pathological upgrade of low-grade intraepithelial neoplasia after ESD.Conclusion Biopsy cannot fully reflect the nature of low-grade intraepithelial neoplasia.When the size of low-grade intraepithelial neoplasia is≥2 cm,attention should be paid to the possibility of pathological upgrading,and biopsy should be actively conducted for reexamination,or even ESD or surgical operation to clarify the nature of the lesion.
作者
吴杨庆
桑建忠
周建波
方莹
Yang-qing Wu;Jian-zhong Sang;Jian-bo Zhou;Ying Fang(Department of Gastroenterology,the Affiliated Yangming Hospital of Ningbo University(Yuyao People’s Hospital),Yuyao,Zhejiang 315400,China)
出处
《中国内镜杂志》
2020年第5期1-6,共6页
China Journal of Endoscopy
基金
浙江省医药卫生科技项目(No:2018KY756)
浙江省医药卫生科技项目(No:2018ZH035)
宁波市医学科技计划项目(No:2016A51)。
关键词
低级别上皮内瘤变
活检
内镜黏膜下剥离术
病理升级
low-grade intraepithelial neoplasia
biopsy
endoscopic submucosal dissection,ESD
pathological upgrade
