【作者】 姜葵； 王艳芳； 王邦茂； 刘文天； 吕宗舜；

【Author】 Jiang Kui Wang Yan-Fang Wang Bang-Mao Liu Wen Tian Lv Zong-Shun Department of Gastroenterology, Tianjin Medical University Affiliated General Hospital Tianjin 300052, China Luan County Traditional Medicine Hospital, Tangshan City, Hebei Province 063700, China

【机构】 天津医科大学总医院； 河北省唐山市滦县中医院；

【摘要】 目的:黏膜切除活检术又称内镜黏膜切除术,是对常规活检难以确诊的病变进行大块黏膜活检的一种方法。本方法不仅是一种诊断方法,也是一种黏膜内早期癌的内镜下治疗方法。本文总结2年内本院进行的胃黏膜切除活检病例, 探讨胃黏膜切除活检术在上胃肠道疾病诊治中的临床意义。方法:2004．1-2006．1本院门诊患者36例,男24例,女12 例,男女比例2:1,年龄45—79岁,平均62岁。切除前用色素内镜或注射色素标记病灶范围,用超声内镜显示病变深度和黏膜下层病变的性质,与固有肌层和血管的关系。确定病灶范围后,于病灶基底部多点注射生理盐水,1:10000肾上腺素生理盐水或高渗盐水,每点1-2ml,使病变处黏膜呈丘样隆起,周围组织呈苍白,用套圈器套住隆起的组织,确认病灶套取无误后,以高频电流进行粘膜切除。取出整个切下的病灶标本先在泡沫塑板上平铺,周边以大头针固定拍照或染色,然后固定送病理检查。早期胃癌诊断根据国际通用标准: 切除胃黏膜标本,胃癌组织浸润限于粘膜层或粘膜下层,无论淋巴结有否转移,进展期胃癌指深度超过粘膜下层,已浸入肌层或浸及浆膜层或浆膜层外组织者。结果:36例患者中, 胃镜下表现:隆起型病变21例,平坦型病变15例。病理结果: 早期胃癌11例(男8例,女3例),进展期胃癌8例,其中皮革胃3例,萎缩性胃炎伴腺体增生6例,MALT淋巴瘤3例, 胃息肉3例(增生性息肉2例,炎性息肉1例),肥厚性胃炎 2例,胃类癌2例,Dieulafoy’s病1例。所有36例患者在接受黏膜切除活检术前均进行过常规活检病理检查(表1)。以黏膜切除活检病理结果为“金标准”,常规活检病理检查与之相比符合率为27．8％(10／36),误诊率72．2％。所有患者术后均常规给予质子泵抑制剂,无出血、穿孔等并发症发生。结论:对于内镜下发现黏膜异常改变而常规活检多次未能确诊的病变或起源于黏膜下层的病变,在色素内镜及超声内镜引导下进行黏膜切除活检可明显提高临床确诊率,安全微创经济,值得推广。更多还原

【Abstract】 Objective: Endoscopic Mucous Resection (EMR) techniques, such as strip biopsy, the injecting and cutting technique, does permit the evaluation of the results of the endoscopic treatment Progresses in EMR are due to the use of the chromoscopy and the submucous injection of various substances (normal and hypertonic saline solution, hyaluronic acid, etc.).The impact of EMR (strip biopsy method) on the selection of subsequent diagnosis for gastric mucosa lesion was analyzed retrospectively. Methods: A total of 36 consecutive patients with gastric mucosa lesion underwent strip biopsy. Resected tissue was assessed histologically. The clinical impact of the strip biopsy result on the subsequent diagnosis strategy was assessed. Results: Among 36 patients, the histological diagnosis after strip biopsy included: early gastric cancer 11, advanced gastric cancer 8, atrophic gastritis 6, MALT lymphoma 3, gastric polyps 3,M e n e trier disease 2, gastric carcinoid 2, Dieulafoy’s disease 1. Every patient had been taken the mucosa biopsy 1-4 times before strip biopsy. The coincident rate was 27.8% (10/36) as well as the misdiagnosis rate was 72.2%. Conclusion: Strip biopsy has a major clinical impact, because it provides an accurate diagnosis, aids in the selection of an appropriate treatment strategy, and reduces unnecessary surgery.更多还原