【摘要】

目的 探讨早期胃癌及癌前病变ESD标本规范化病理评估的临床意义。

方法  2012年7月至2015年9月间，连续收治行ESD治疗的80例早期胃癌及癌前病变患者纳入回顾性研究，入选病例均有ESD术前胃镜活检及术后病理诊断结果，标本规范化处理和病理学评估均参照日本胃癌处理指南进行。观察胃镜活检与ESD标本的诊断符合率，并综合评估病例的ESD绝对适应证或扩大适应证、治愈性或非治愈性切除等情况。

结果 80例胃ESD标本中，9例（11.25％）为低级别上皮内瘤变（LGIN），41例（51.25％）为高级别上皮内瘤变（HGIN），其余30例（37.50％）为早期胃癌（其中分化型癌26例、未分化型癌4例），其中54例术前活检与ESD术后诊断一致（符合率为67.50％）。6例合并溃疡形成，包括2例HGIN及4例早期胃癌。垂直切缘均阴性，2例HGIN及3例早期胃癌水平切缘阳性。30例早期胃癌均未见明确脉管癌栓，22例为ESD绝对适应证，8例为扩大适应证。24例标本为治愈性切除（治愈性切除率为80.00％），6例为非治愈性切除，其中3例非治愈性切除追加手术，余随访未见复发。

结论 ESD手术标本病理学的规范化评估和规范化报告，能够客观反映ESD手术治疗情况，对指导进一步治疗及综合评估患者预后具有重要的临床意义。

【关键词】早期胃癌；上皮内瘤变；内镜黏膜下剥离术；病理学评估

Processing of specimens and standardized pathological evaluation of endoscopic submucosal dissection for early gastric cancer and precancerous lesion in 80 cases

Liang Li， Zhang Jixin， Rong Long， Liu Ping，Li Ting.Department of Pathology， Peking University First Hospital， Beijing 100034，China

Corresponding author: Li Ting， Email： lixiaoting12@hotmail.com

【Abstract】

Objective To study the standardized pathological evaluation of early gastric cancer and precancerous lesions and its significance for endoscopic submucosal dissection（ESD）. 

Methods A total of 80 cases of early gastric cancer and precancerous lesions were collected in the center of endoscopy from July 2012 to September 2015， who were treated by ESD. The pathological diagnosis of all cases before and after ESD was obtained. Specimens were processed and pathologically evaluated according to Japanese gastric cancer treatment guidelines. The diagnostic consistency of ESD with gastric biopsy was determined， and absolute indication， expanded indication， curative resection， and non-curative resection as well. 

Results  There were 9 cases（11.25％） of low grade intraepithelial neoplasia， 41 cases（51.25％） of high grade intraepithelial neoplasia， and 30 cases（37.50％） of early gastric cancer， with 26 cases of differentiated adenocarcinoma and 4 cases of undifferentiated adenocarcinoma. Preoperative biopsy findings were consistent with post-ESD diagnosis， and the consistency was 67.50％. Six cases also showed ulcer， with 2 cases of high grade intraepithelial neoplasia and 4 cases of early gastric cancer. The vertical margins were negative in all 80 cases， while positive horizontal margin was found in 2 cases of high grade intraepithelial neoplasia and 3 cases of early gastric cancer. No vessel invasion was observed in 30 cases of early gastric cancer. Integrated analysis showed that 22 cases met with absolute indication， 8 cases with expanded indication. After ESD， 24 cases were curative resections whereas 6 cases were considered as non-curative resections（the curative rate was 80.00％）， 3 non-curative resection cases were treated with further surgery， and the other 3 cases did not relapse after follow-up. 

Conclusion The standard pathological evaluation and report of ESD specimen objectively reflects the treatment of ESD and plays an important clinical role in the further treatment and comprehensive evaluation of prognosis.

【Key words】Early gastric cancer；Intraepithelial neoplasia；Endoscopic submucosal dissection；Pathological evaluation

原文见《中华消化内镜杂志》2016年第9期589页