食管黏膜病变术前活检与内镜术后病理的异同分析

目的 回顾性分析笔者医院食管黏膜病变内镜下治疗术后病理及术前胃镜活检病理结果，比较二者的异同。方法 回顾性收集2013年1月~2016年6月在笔者医院因食管黏膜病变行内镜下治疗的患者114例，全身麻醉下行内镜下治疗，术后标本送病理学检查，比较术前胃镜活检病理与内镜术后病理之间的差异。结果 114例食管黏膜病变患者均成功行EMBM或ESD切除病变，其中术前活检病理为低级别上皮内瘤变患者51例，高级别上皮内瘤变患者60例，早期癌患者3例；所有114例患者术前胃镜活检病理和内镜术后病理总符合率为62.3%（71/114）。术前病理为低级别上皮内瘤变患者的患者中，术后病理为低级别上皮内瘤变、高级别上皮内瘤变和早癌者分别为28例、22例和1例，胃镜活检符合率为54.9%（28/51），而有45.1%（23/51）患者术后病理级别高于术前胃镜活检病理；术前活检病理为高级别上皮内瘤变患者中，术后病理为低级别、高级别和早癌者分别为16、40和4例，符合率为66.7%（40/60），有6.7%（4/60）患者病理级别升高，26.7%（16/60）病理级别降低；3例胃镜活检提示为早期癌患者术后病理仍为早期癌，符合率为100%。结论 胃镜活检对食管黏膜病变有较好的提示作用，但胃镜活检病理和内镜治疗术后病理仍有一定差异性，多数差异表现为术后病理级别较胃镜活检病理级别的升高，对于发现食管癌前病变和早期癌的患者应积极行内镜治疗。

Analysis of the Pathological Features Between the Pathology of Esophageal Mucosa Lesions of Preoperative Gastroscopic Biopsy and Post Procedure

Objective To retrospective analyze and compare the pathology of preoperative gastroscopic biopsy and postoperative results. Methods A total of 114 patients diagnosed as having esophageal mucosal lesions by endoscopic biopsy were treated with ESD or EMBM in Nanjing General Hospital of Nanjing Military region from January, 2013 to June, 2016. ESD or EMBM were performed under general anesthesia and the postoperative specimens were examined by routine pathology. The differences between the preoperative pathology and post procedure were analyzed. Results All 114 esophageal mucosal lesions patients were successfully underwent ESD or EMBM. Totally 51 cases were preoperative gastroscopic biopsy diagnosed as low grade intraepithelial neoplasia (LGIEN). 60 cases were preoperative gastroscopic biopsy diagnosed as grade intraepithelial neoplasia (HGIEN) and 3 cases were early esophageal cancer. The consistence rate of gastroscopic biopsy and postoperative pathological results was 62.3% (71/114). Among LGIEN patients, 28 cases were diagnosed as LGIEN, 22 cases were diagnosed as HGIEN and 1 case was diagnosed as early esophageal cancer post operation. The consistence rate was 54.9%(28/51)and 45.1%(23/51)cases were underestimated. In HGIEN group, the postoperative results were 16 cases of LGIEN, 40 cases of HGIEN and 4 cases of early esophageal cancer. The consistence rate in patients of which gastroscopic biopsy were HGIEN was 66.7% (40/60), 6.7% (4/60) cases were underestimated and 26.7% (16/60) were overestimated. The 3 patients, which preoperative gastroscopic biopsy diagnosed as early esophageal cancer, were also diagnosed as early esophageal cancer post operation and the consistence rate was 100%. Conclusion Preoperative pathological diagnosis has certain value for esophageal mucosal lesions. There were differences between preoperative biopsy and postoperative pathology. Most differences indicated that higher pathological grades in postoperative results. Therefore, patients with early esophageal cancer and esophageal precancerous lesions diagnosed by gastroscopy need active endoscopic therapeutic measures.