内镜黏膜下剥离术治疗早期胃癌及癌前病变的效果及术后病理分析

目的 探讨并评估内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的价值，分析术前与术后病理结果的差异。方法 选取2020年1月至2022年5月于南京医科大学附属江宁医院消化内科住院的EGC或癌前病变患者57例，术前均予胃镜活检病理诊断，给予ESD治疗。分析治疗的效果、手术时间、住院时间、术后并发症，对比术前与术后病理结果的差异。结果 57例患者共切除病灶63个，病灶直径0.6～9.0 cm,整块切除率98.41%(62/63),完整切除率95.24%(60/63),治愈性切除率93.65%(59/63),平均手术时间(2.2±1.6)h,平均住院时间(9.3±2.9)d。术前活检与术后病理诊断结果总符合率60.32%(38/63),完全一致率46.03%(24/63)。术后并发出血1例，于内镜下成功止血；发热4例，恶心伴腹痛1例，均经对症处理后好转。结论 ESD治疗EGC及癌前病变安全、有效，并发症少。术前活检病理不完全等同于术后病理结果，通过ESD可完整切除病灶并进一步行病理学评估，从而减少误诊、漏诊发生。

Clinical value and postoperative pathological analysis of endoscopic submucosal dissection in the treatment of early gastric carcinoma and intraepithelial neoplasia

Objective To explore and evaluate the clinical value of endoscopic submucosal dissection (ESD) in the treatment of patients with early gastric carcinoma (EGC) and intraepithelial neoplasia, observe and analyze the difference between preoperative and postoperative pathological results. Methods Fifty-seven patients with EGC or intraepithelial neoplasia of the gastroenterology?department were collected from January 2020 to May 2022. All patients were treated with ESD at the early stage of gastric carcinoma or intraepithelial neoplasia.The effectiveness of treatment,?operation?time, hospitalization?time and postoperative complications were retrospectively observed and analyzed, and the differences between preoperative and postoperative pathology were analyzed and compared. Results Among the sixty-three lesions of fifty-seven patients, the minimum diameter was 0.6cm and the maximum diameter was 9.0cm. The whole piece resection rate was 98.41% (62/63), the complete resection rate was 95.24% (60/63), and the curative resection rate was 93.65% (59/63).The average operation time was 2.2±1.6h, and the average hospitalization?time was 9.3±2.9d .One case of postoperative bleeding occurred,which was successfully managed by endoscopic treatment.Four cases had a fever, and only one case occurred nausea and stomachache after operation.The total accordance rate of pathological diagnosis between preoperative biopsies and postoperative specimens was 60.32% (38/63), and the full consistency rate was 46.03% (24/63). Conclusion EGC and intraepithelial neoplasia can be treated by ESD safely and efficiently with fewer complications. Biopsy pathology before ESD is not completely equivalent to postoperative pathological results. we can get complete postoperative specimens for further pathological examination by ESD ,which can?reduce?clinical missed diagnosis and misdiagnosis.