不同手术前活检方案对早期胃癌及上皮内瘤变行ESD效果的影响

摘要

Objective To explore the use of different preoperative surgical biopsies on endoscopic submucosal dissec-tion (ESD) in patients with early gastric cancer or intraepithelial neoplasia. Method 90 cases of early gastric cancer or intraepithelial neoplasia who underwent ESD were included in the study as control group (n=40) or study group (n=50) depending on the respective preoperative endoscopic examinations;Patients of control group in different hospitals were administered with conventional white light imaging (C-WLI) endoscopy for multiple biopsies, followed by magnifying endoscopy with narrow band imaging (M-NBI), while patients in study group were first checked with C-WLI, and then were given M-NBI, the effect of different preoperative biopsy regimens on ESD in those patients with early gastric cancer or intraepithelial neoplasia were compared, and relevant indicators were observed. Result The consistency of M-NBI was 95.6%, and was 70.0%for C-WLI, with significant differences observed (P<0.05.);The time of removing specimens, marking, and of specimen processing in the two groups were of no significant difference (P>0.05), while the time of sub-mucosal injection, time of mucosal membrane separation and time of surgical debriding were significantly shorter in study group than the control group (P<0.05), and less biopsies in the study group were collected after surgery (P<0.05);The pathological consistency of specimens in study group was 96.0%, and was 77.5%in the control group, with signifi-cant differences observed (P<0.05.);The overall specimen was less in study group than the control group (P<0.05). Con-clusion M-NBI may improve the positive rate of specimens, with less time spent on ESD, reducing the specimens need-ed, which is clinically applicable.%目的：探讨采用不同手术前活检方案对早期胃癌及上皮内瘤变患者行内镜黏膜下剥离术（ESD）效果的影响。方法选择早期胃癌或者上皮内瘤变行ESD患者90例，根据术前胃镜的检查方式的不同分为对照组（40例）和观察组（50例），对照组患者在不同医院采用传统白光成像内镜（C-WLI）进行多块多次活检方案，再进行放大窄带成像内镜（M-NBI）模式检查，观察组在本院先应用C-WLI，进而进行M-NBI模式，比较不同手术前活检方案对早期胃癌及上皮内瘤变行ESD效果的影响，观察患者手术进行中的相关指标。结果 M-NBI的符合率为95.6%，C-WLI的符合率为70.0%，两种不同活检方案比较差异具有统计学意义（P﹤0.05）；对照组和观察组在标本切除范围时间、标记时间以及处理标本时间差异无统计学意义（P﹥0.05）；观察组在手术过程中黏膜下注射时间、黏膜分离时间以及手术创面处理时间短于对照组，同时手术后活检标本数量少于对照组（P﹤0.05）；观察组取出的标本病理检查符合率为96.0%，对照组的符合率为77.5%，差异具有统计学意义（P﹤0.05）；观察组取材标本数量少于对照组（P﹤0.05）。结论采用放大窄带成像内镜活检方法，能够提高取材阳性率，缩短内镜下ESD手术时间，减少取材标本数量，值得临床推广。