CAJ | 학술논문

目的应用常规内镜及共聚焦激光显微内镜(CLE)对胃黏膜高级别上皮内瘤变(HGIEN)患者病灶行再次检查,从中鉴别浸润性胃癌.方法选取2005年1月至2010年12月间上海交通大学医学院附属瑞金医院消化科82例胃镜活检病理检查为HGIEN者,男性61例,女性21例,其中38例行普通胃镜检查,44例除普通胃镜检查外还接受了CLE检查.对比内镜活检病理诊断,符合指征者行手术及病理学检查.结果 82例患者中经复查证实,良性溃疡或炎性反应8例(24.4％),胃黏膜低级别上皮内瘤变12例(14.6％),HGIEN 10例(12.2％),浸润性胃癌52例(63.4％).浸润性胃癌患者中分化型癌36例,未分化型癌16例.CLE诊断为浸润性胃癌的21例中,17例(81.0％)与病理学诊断一致,CLE诊断与病理诊断一致性参数κ值=0.7250.结论从内镜活检病理诊断胃黏膜HGIEN患者中鉴别浸润性胃癌是必要的.
목적 응용상규내경급공취초격광현미내경(CLE)대위점막고급별상피내류변(HGIEN)환자병조행재차검사,종중감별침윤성위암.방법 선취2005년1월지2010년12월간상해교통대학의학원부속서금의원소화과82례위경활검병리검사위HGIEN자,남성61례,녀성21례,기중38례행보통위경검사,44례제보통위경검사외환접수료CLE검사.대비내경활검병리진단,부합지정자행수술급병이학검사.결과 82례환자중경복사증실,량성궤양혹염성반응8례(24.4％),위점막저급별상피내류변12례(14.6％),HGIEN 10례(12.2％),침윤성위암52례(63.4％).침윤성위암환자중분화형암36례,미분화형암16례.CLE진단위침윤성위암적21례중,17례(81.0％)여병이학진단일치,CLE진단여병리진단일치성삼수κ치=0.7250.결론 종내경활검병리진단위점막HGIEN환자중감별침윤성위암시필요적.
Objective To screen gastric infiltrating carcinoma from gastric high grade intraepithelial neoplasia (HGIEN) checked again by regular gastroscopy and confocal laser endomicroscopy(CLE).Methods From January 2005 to December 2010,82 patients with endoscopic biopsy and the tissue pathological diagnosed HGIEN were collected at Department of Gastroenterology,Ruijin Hospital,Jiaotong University.61 male patients and 21 female patients were collected,of which 38 patients underwent common gastroendoscopy and the other 44 patients were underwent CLE besides common gastroendoscopy.The pathological diagnosis of endoscopic biopsy tissues were compared,and patients with indications were referred to surgery and pathological examination again.Results A total of 82 patients were confirmed by repeated examination,and there were 8 cases of inflammation or benign ulcers (24.4％),12 cases of low grade intraepithelial neoplasia (14.6％),10 cases of HGIEN (12.2％),52 cases of infiltrating carcinoma (63.4％).36 cases of differentiated carcinoma and 16 cases of undifferentiated carcinoma.Of the 21 infiltrating carcinoma cases diagnosed by CLE,17 cases (81.0％) were consistent with the pathological diagnosis.The consistent parameter value of κ between CLE diagnosis and pathological diagnosis was 0.7250.Conclusion It is necessary to make differential diagnosis of infiltrating cancer in patients with endoscopic biopsy and the tissue pathological diagnosed HGIEN.