胃低级别上皮内瘤变内镜黏膜下剥离术后病理升级的危险因素分析*

Analysis of risk factors for postoperative pathological upgraded of gastric low-grade intraepithelial neoplasia after endoscopic submucosal dissection*

摘要:

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?

Abstract:

Absrtact: 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.