摘要目的 探讨胃黏膜活组织检查病理诊断高级别上皮内瘤变(IN)患者胃镜所见及与术后病理的关系.方法 回顾分析51例经胃镜钳取活组织病理诊断为胃黏膜高级别IN患者的胃镜下表现,并对照分析其中33例接受外科手术切除标本的病理学检查结果.结果 胃镜下有29例(56.9%)的病灶分布在胃窦部,11例(21.6%)在胃体,1例(2.0%)广泛累及胃窦胃体,其余10例分别在胃角和胃底;43例(84.3%)的浅表病灶形似早期胃癌样表现,另有8例(15.7%)的病灶形似进展期胃癌样.接受手术治疗的33例患者中,13例(39.4%)术后病理证实维持高级别IN的诊断.胃镜下病灶形态均为浅表病变,大小均不足20 mm;其余20例(60.6%)术后则诊断为胃癌,其中早期胃癌14例,进展期胃癌6例.结论 胃镜下胃黏膜活检诊断高级别IN的患者存在胃癌的概率高,应积极随访甚至手术干预.

abstractsObjective To investigate the association between the morphological features of biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa and the postoperative pathology.Methods Fifty-one patients with biopsy-diagnosed high grade intraepithelial neoplasia in the gastric mucosa were retrospectively analyzed.Thirty-three patients underwent surgery.The morphology of lesions under endoscopy and histopathological findings of the surgical specimens were investigated.Results Of the 51 patients,43 had surperficial lesions similar to early gastric cancer under endoscopy,8 were similar to advanced carcinoma.In the 33 surgical cases,high grade intraepithelial neoplasia of gastric mucosa was confirmed on postoperative pathological examination in 13(39.4%)patients,adenocarcinoma was identified in the remaining 20 patients(60.6%),including 14 early gastric cancers and 6 advanced carcinomas.Thirteen cases with high grade intraepitbelia]neoplasia confirmed postoperatively were superficial elevated or flat lesions less than 20 mm.Conclusions Patients with biopsy-diagosed high grade intraepithelial neop]asia in the gastric mucosa have a high risk of cancer.Thus aggressive follow-up and appropriate surgical interventions are recommended to avoid misdiagnosis.