CAJ | 학술논문

目的评价胃高级别上皮内瘤变(HIN)这一概念在临床应用中的价值和不足.方法回顾性分析经胃镜活检病理诊断为HIN的45例患者的临床和病理资料,并与术后病理诊断结果进行对比研究.结果本组患者33例接受远端胃大部切除术,3例行近端胃大部分切除术,7例行全胃切除术,2例行内镜黏膜切除术.术后病理结果显示,15例(33.3%)维持HIN的诊断:14例(31.1%)为早期胃癌,16例(35.6%)为进展期胃癌,其中40.0%(12/30)伴有局部淋巴结转移.术前胃镜活检显示直径大于或等于3 cm、伴有溃疡或具有低分化癌特点的HIN病灶.术后多提示为癌(P<0.05).对于胃癌患者,具有上述特征者多为进展期胃癌,易发生淋巴结转移(P<0.05).结论术前采用胃镜病理活检对HIN作出诊断应慎重;当HIN病灶直径大于或等于3 cm、伴有溃疡或具有低分化癌特点时,建议选择积极的根治性手术治疗.
목적 평개위고급별상피내류변(HIN)저일개념재림상응용중적개치화불족.방법 회고성분석경위경활검병리진단위HIN적45례환자적림상화병리자료,병여술후병리진단결과진행대비연구.결과 본조환자33례접수원단위대부절제술,3례행근단위대부분절제술,7례행전위절제술,2례행내경점막절제술.술후병리결과현시,15례(33.3%)유지HIN적진단:14례(31.1%)위조기위암,16례(35.6%)위진전기위암,기중40.0%(12/30)반유국부림파결전이.술전위경활검현시직경대우혹등우3 cm、반유궤양혹구유저분화암특점적HIN병조.술후다제시위암(P<0.05).대우위암환자,구유상술특정자다위진전기위암,역발생림파결전이(P<0.05).결론 술전채용위경병리활검대HIN작출진단응신중;당HIN병조직경대우혹등우3 cm、반유궤양혹구유저분화암특점시,건의선택적겁적근치성수술치료.
Objective To evaluate the value and inadequacy in clinical practice of the concept of gastric high-grade intraepithelial neoplasia (HIN). Methods Forty-five cases with gastric HIN diagnosed by the esophagogastroduodenoscopy (EGD) biopsy were treated from 2003 to 2009.The clinical and histopathological data were analyzed retrospectively. Results Radical surgeries were successfully performed on all the patients,among whom 33 underwent distal subtotal gastrectomy,3 proximal partial gastrectomy,7 total gastrectomy,and 2 endoscopic mucosal resection.In postoperative pathological examination,only 15 cases(33.3%) were HIN,while 14 cases(31.1%)were found to be early gastric cancers,and 16(35.6%)were advanced cancers.Twelve(40.0%)out of 30 cancers had regional lymph nodes metastasis.When the maximum diameter of the HIN lesion was greater than 3.0 cm,or when ulcer or the features of poorly-differentiated carcinoma or signet-ring cell carcinoma were present in preoperative biopsy,the likelihood of cancer in postoperative pathological examination was higher(P<0.05),and when malignancy was confirmed,the presence of the features above was associated with lymph nodes metastasis and advanced cancer. Conclusions Carcinoma is identified in a large proportion of patients with gastric HIN by the EGD biopsy.Lymph nodes metastasis or advanced cancer may be detected in these cases.Cautions must be taken when the new concept of HIN is widely used for diagnosing gastric lesion.Radical resection should be considered when the maximum diameter of the HIN lesion is greater than 3.0 cm,or when ulcer,or the feature of poorly-differentiated carcinoma or signet-ring cell carcinoma are present in the EGD biopsy.