胃镜活检在食管黏膜病变治疗中的价值

目的 探讨术前活检在内镜黏膜下剥离术（endoscopic submucosal dissection，ESD） 治疗食管黏膜病变中的价值。 方法 回顾总结2008 年1 月- 2013 年6 月我院消化内镜中心177 例（186 个病灶） 术前活检病理确诊为早期食管癌及上皮内瘤病变患者的临床资料，对比分析ESD 前后病理结果的差异性。 结果 术前活检的186 例病变提示为低级别上皮内瘤变（lowgrade gastric intraepithelial neoplasia，LGIN）23 例，高级别上皮内瘤变（high-grade gastric intraepithelial neoplasia，HGIN）143例，早期食管癌20 例。术后病理诊断为LGIN 32 例，HGIN 73 例，早期食管癌70 例，炎症11 例。术前病理与术后病理总符合率达95.2%（177/186），完全一致率为49.46%（92/186），其中LGIN 完全一致率为56.5%（13/23），HGIN 完全一致率为44.76%（64/143），早期食管癌完全一致率为75.0%（15/20），一致率最高。23 例LGIN 中，3 例术后病理证实为早期食管癌（13.0%，3/23），143 例HGIN 中52 例术后诊断为早期食管癌（36.36%，52/143），癌变率比较差异有统计学意义（P ＜ 0.05）。 结论 术前活检与术后病理结果有一定差距，胃镜活检病理为HGIN 的患者超过1/3 术后病理已经证实癌变，应给予积极治疗，以免贻误病情。

Value of preoperative biopsy in the treatment of esophagus lesions by endoscopic submucosal dissection

Objective To discuss the application value of preoperative biopsy in the treatment of esophagus lesions by endoscopic submucosal dissection （ESD）. Methods Clinical data of 177 patients （186 lesions） who had been diagnosed with esophagus intraepithelial neoplasia （EIN） or early cancer by preoperative biopsy from January 2008 to June 2013 in our digestive endoscopy center were summarized retrospectively, and the discrepancy of pathological diagnosis between endoscopic biopsies and specimens after ESD was analyzed. Results Among the 186 lesions of preoperative biopsies, 23 cases were low-grade gastric intraepithelial neoplasia （LGIN）, 143 cases were high-grade gastric intraepithelial neoplasia （HGIN） and 20 cases were early esophagus cancer. After ESD, 32 cases were low-grade gastric intraepithelial neoplasia （LGIN）, 73 cases were high-grade gastric intraepithelial neoplasia （HGIN）, 70 cases were early esophagus cancer and 11 cases inflammation. The total accordance rate of pathological diagnosis between preoperative biopsies and postoperative specimens was 95.2% （177/186） and the full consistency rate was 49.46% （92/186）. Of LGIN, the full consistency rate was 56.5% （13/23）, of HGIN was 44.76% （64/143） and of early cancer was 75.0% （15/20） which was the highest. Among the 23 cases in LGIN and 143 cases in HGIN of preoperative biopsies, there were 3 cases （13.0%, 3/23） and 52 cases （36.36%, 52/143） respectively whose pathological diagnosis were confirmed for cancer after ESD. There was statistical difference between the canceration rate of LGIN group and HGIN group （P 〈 0.05）. Conclusion There is a certain gap between preoperative biopsy and postoperative pathology. More than one third of biopsy diagnosed HGIN are confirmed to be carcinoma after ESD, which need active measures so as not to bungle the illness.