内镜黏膜下剥离术治疗食管和胃早癌及癌前病变的价值以及术后病理差异分析（附337例报告）

Clinical value and postoperative pathological analysis in early esophageal and gastric carcinoma and intraepithelial neoplasia treated by endoscopic submucosal dissection

摘要:

摘要：目的??探讨内镜黏膜下剥离术（ESD）治疗食管和胃早癌及癌前病变的临床疗效，并分析手术前后标本病理特点的差异。方法?337例研究对象术前经胃镜活检标本检查确诊为早期食管癌、早期胃癌或癌前病变，均经ESD治疗，观察其临床表现特征、术前及术后病理特点的差异等。结果?共切除病灶372处，其中多发病变30例。术前钳取活检总正确率为55.91%（208/372），漏诊率6.72%（25/372），对高级别上皮内瘤变（HGIN）和早癌的低估率为19.86%（29/146）。边缘/基底阳性率4.57%（17/372）。结论?ESD是治疗食管及胃早癌及癌前病变的有效方法，并且可以提高病理的诊断正确率。ESD术前的病理活检正确率需进一步提高。ESD病理标本阳性与术前判断病变、ESD操作有关。

Abstract:

Abstract: Objective?To evaluate the effect and pathological characters for patients with early esophageal and gastric carcinoma and intraepithelial neoplasia after endoscopic submucosal dissection (ESD).?Methods?337 patients from January 2013 to June 2017 were enrolled in the study. All the patients were treated with ESD at the early stage of esophageal and gastric carcinoma and intraepithelial neoplasia. The patients’ clinical features, and the size of the lesions were collected. The postoperative complications and pathological characteristics were analyzed.?Results?Among the 337 cases, 2 were invasive carcinoma, 27 were early carcinoma, 119 were high-grade intraepithelial neoplasia and 153 were low-grade intraepithelial neoplasia. Biopsy accuracy was 55.91% (208/372). 25 cases were mis-diagnosed. The underestimation rate of high-level intraepithelial neoplasia and early cancer was 19.86% (29/146). The total incomplete resection rate after ESD was 4.57% (17/372).?Conclusion?The early esophageal and gastric carcinoma and intraepithelial neoplasia can be treated with ESD, which can provide complete specimen for further pathological assessment, in order to improve the diagnostic accuracy. The biopsy accuracy need to be improved. The incomplete resection is related to ESD procedure and estimation of invasive demarcation and depth before ESD.