ESD术前病理提示食管LGIN病人术后出现病理升级的相关因素分析

目的分析内镜黏膜下剥离术（ESD）术前病理提示食管低级别上皮内瘤变（LGIN）病人术后出现病理升级的相关因素。方法回顾性分析2013年3月至2018年3月83例ESD术前病理提示食管LGIN病人的临床资料，通过单因素及多因素logistic回归分析病人ESD术后出现病理升级的相关影响因素。结果83例ESD术前病理提示食管LGIN病人中，ESD术后出现病理升级44例（53.01%），其中升级至早期食管鳞癌8例，高级别上皮内瘤变（HGIN）36例；术后病理仍提示食管LGIN者35例（42.17%），提示食管慢性炎症4例（4.82%）。其中，ESD术前行窄带成像放大内镜诊断35例，准确判断浸润深度者30例，准确率为85.71%（30/35）。经单因素分析结果发现，伴有结节样改变、黏膜表面发红的病人ESD术后病理升级的发生率较无结节样改变、无黏膜表面发红者升高（P < 0.01和P < 0.05）；而不同性别、年龄、内镜分型、病变范围、病变部位及病变形态的病人ESD术后病理升级发生率的比较差异无统计学意义（P>0.05）。经多因素logistic回归分析结果发现，结节样改变（OR=3.86，95%CI:1.63~9.14）、黏膜表面发红（OR=2.95，95%CI:1.60~5.41）是食管LGIN病人ESD术后出现病理升级的影响因素（P < 0.01）。结论ESD术前病理提示食管LGIN病人术后出现病理升级的情况并不少见，且结节样改变、黏膜表面发红是ESD术后出现病理升级的危险因素，临床中对此类病人应提高警惕，行窄带成像放大内镜诊断辅助病理检查对提高ESD术前病理评估的准确性具有重要临床意义。

Related factors analysis of the pathological escalation in patients with esophageal LGIN after ESD

ObjectiveTo analyze the related factors of pathological escalation after endoscopic submucosal dissection(ESD) in patients with low-grade intraepithelial neoplasia(LGIN) of esophagus.MethodsThe clinical data of 83 patients with esophageal LGIN diagnosed by pathology before ESD from March 2013 to March 2018 were retrospectively analyzed.The univariate and multivariate logistic regression analysis were used to analyze the related factors of pathological escalation after ESD.ResultsAmong 83 cases with esophageal LGIN, there were 44 cases(53.01%) with pathological escalation after ESD, which included 8 cases of early esophageal squamous cell carcinoma and 36 cases of high-grade intraepithelial neoplasia(HGIN).The results of postoperative pathology showed that 35 cases(42.17%) were esophageal LGIN, and 4 cases(4.82%) were chronic esophageal inflammation.Thirty-five cases were diagnosed using narrow-band imaging magnifying endoscopy before ESD, the depth of invasion in 30 cases were accurately judged, and the accuracy rate of which was 85.71% (30/35).The results of univariate analysis showed that the incidence rate of the pathological escalation in patients with nodular changes and reddening of mucosal surface was significantly higher than that in patients without nodular changes and redness of mucosal surface(P < 0.01 and P < 0.05), but there was no statistical significance in the incidence rate of pathological escalation in patients with different gender, ages, endoscopic classification, lesion ranges, lesion location and lesion morphology(P>0.05).The results of multivariate logistic regression analysis showed that nodular changes(OR=3.86, 95%CI:1.63-9.14) and mucosal surface rednes(OR=2.95, 95%CI:1.60-5.41) were the influencing factors of pathological escalation in patients with esophageal LGIN after ESD(P < 0.01).ConclusionsThe postoperative pathological escalation of esophageal LGIN is common, and the nodular changes and redness of mucosal surface are the risk factors of pathological escalation.In clinical practice, we should pay more attention to this kind of patients.It is of great clinical significance to improve the accuracy of preoperative pathological evaluation using narrow-band imaging magnifying endoscopy diagnosis and auxiliary pathological examination.