杨尧尧,
李春艳^,,
孟华,
白托娅,
窦菲菲,
王璐,
王鑫
大连医科大学附属第一医院 消化内科，辽宁 大连 116011

详细信息 作者简介: 杨尧尧（1997-），女，硕士研究生。E-mail：yangyaoyao0220@163.com







通讯作者: 李春艳，教授。E-mail：lichunyandoctor@126.com 中图分类号: R573.9


摘要:目的分析探讨慢性胃炎伴胃黏膜低级别上皮内瘤变（LGIN）患者内镜黏膜下剥离术（ESD）术后病理出现升级的危险因素。方法收集2021年2月至2022年11月因胃镜病理活检诊断为慢性胃炎伴黏膜LGIN，于大连医科大学附属第一医院行ESD患者的临床资料。共154例患者入组，根据活检及ESD术后病理结果，分为慢性胃炎伴LGIN术后病理未升级A组113例，慢性胃炎伴LGIN术后病理升级B组41例。164处病灶分为术后病理未升级A1组121处病灶和术后病理升级B1组43处。66例患者共68处病灶行窄带成像联合放大内镜检查（ME-NBI），其中术后病理未升级A2组51处，术后病理升级B2组17处。比较各组一般临床资料和内镜下病灶特点，通过多因素分析探讨ESD术后病理升级的危险因素。结果B组Hp感染率高于A组，差异有统计学意义（P＜0.05）。A1、B1两组病灶颜色改变情况差异有统计学意义（P＜0.05）。A1组病灶直径1.0（0.8，1.5）cm，B1组病灶直径1.5（1.2，2.0）cm，差异具有统计学意义（P＜0.05）。A2组微腺管紊乱、微血管扭曲比率低于B2组，差异具有统计学意义（P＜0.05）。多因素分析结果显示，病灶直径＞1.5 cm是胃LGIN患者ESD术后出现病理升级的独立危险因素（P＜0.05）。结论胃镜活检存在漏诊率，病灶直径＞1.5 cm、颜色发红、ME-NBI下黏膜表面微结构改变如微腺管紊乱和微血管扭曲、合并Hp感染应警惕病理升级的可能。
关键词: 胃黏膜低级别上皮内瘤变/
内镜黏膜下剥离术/
病理升级/
危险因素


Abstract:ObjectiveTo investigate the risk factors for pathological upgrading after endoscopic submucosal dissection (ESD) in patients with chronic gastritis and mucosal low-grade intraepithelial neoplasia (LGIN).MethodsThe clinicopathologic data of the patients diagnosed with chronic gastritis accompanied by mucosal LGIN in the First Affiliated Hospital of Dalian Medical University from February 2021 to November 2022 were collected. A total of 154 patients were enrolled, and according to the biopsy and ESD postoperative pathological results, they were divided into chronic gastritis with LGIN postoperative pathological unupgrade group A (113 cases) and chronic gastritis with LGIN postoperative pathological upgrade group B (41 cases). The 164 lesions were divided into group A1 (121 lesions) with no postoperative pathological upgrade and group B1 (43 lesions) with postoperative pathological upgrade. A total of 68 lesions (66 patients) were examined by narrow-band imaging combined with amplification endoscopy (ME-NBI), including 51 lesions in the A2 group with no postoperative pathological upgrade and 17 lesions in the B2 group with postoperative pathological upgrade. The general clinical data and endoscopic lesion characteristics of each group were analyzed and compared, and the risk factors of postoperative pathological progression were discussed by multi-factor analysis.ResultsThe positive rate of Hp in group B was higher than that in group A (P＜0.05). There was a significant difference in color composition between the A1 and B1 groups (P＜0.05). The lesion size was 1.0 (0.8, 1.5) cm group A1 and 1.5 (1.2, 2.0) cm in group B1, the difference was statistically significant (P＜0.05). The microglandular duct disorder and microvascular distortion in A2 group were lower than those in B2 group (P＜0.05). Multivariate analysis revealed that lesion size＞1.5 cm was an independent risk factor for postoperative pathological progression in patients with gastric LGIN (P＜0.05).ConclusionGastric biopsy under endoscopy has a certain rate of missed diagnosis. Lesions with the size greater than 1.5 cm, redness in color, mucosal surface microstructure changes under ME-NBI, such as microglandular canal disturbance and microvascular distortion, in combination with Hp infection should be vigilant against the possibility of pathological progression.
Keywords:gastric low-grade intraepithelial neoplasia/
endoscopic submucosal dissection/
pathological upgrade/
risk factors

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