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目的探讨术前内镜粘膜活检对恶性病变的诊断价值及其与外科病理诊断的差异.方法对经内镜活检并经外科切除的199例上消化道恶性肿瘤标本进行组织病理学对照分析,探讨活检对恶性肿瘤的确诊率及其与内镜下粘膜形态、组织学类型的关系,比较其与外科病理诊断在肿瘤的分化程度判断上的差别.结果上消化道内镜活检确诊率79.4%,疑诊11.1%,未能诊断者占9.5%.活检确诊率以肿块型病变确诊率最高,溃疡型次之,弥漫僵硬型和狭窄型病变内镜活检确诊率较低.就组织学类型而言,以鳞癌和腺癌检出率较高,分别达88.3%和79.6%.对腺鳞癌、类癌及未分化癌检出率较低,对平滑肌肉瘤等活检对恶性判断的意义不大.结论内镜活检虽在术前对上消化道恶性肿瘤诊断有决定性的意义,但是由于取材所限,反映病变性质不够全面,对恶性肿瘤诊断存在一定误差.
Objective To investigate the diagnostic value of preoperative endoscopic mucosal biopsy for malignant lesions and its difference with surgical pathological diagnosis.Methods Histopathological analysis of 199 cases of upper gastrointestinal cancer patients who underwent endoscopic biopsy and surgical resection Biopsy of malignant tumor diagnosis and its relationship with endoscopic mucosal morphology and histological types of comparison with the surgical pathological diagnosis in the differentiation of the tumor to determine the difference between the results of upper gastrointestinal endoscopy biopsy 79.4% 11.1% of suspected and 9.5% of those who failed to diagnose.The biopsy confirmed the highest rate of diagnosis of mass lesions, followed by ulcer type, diffuse rigid and narrow lesions endoscopic biopsy confirmed the low rate of histological types , The detection rate of squamous cell carcinoma and adenocarcinoma were 88.3% and 79.6% respectively.The detection rate of adenosquamous carcinoma, carcinoid carcinoma and undifferentiated carcinoma was low, and the biopsy of leiomyosarcoma had little significance for malignant judgment .Conclusion Although endoscopic biopsy has a decisive significance in the diagnosis of upper gastrointestinal cancer before surgery, it is not comprehensive enough to reflect the nature of the lesion because of the limitations of drawing, and there are some errors in the diagnosis of malignant tumors.