| purpose:From December 2013 to December 2017,the clinical,endoscopic examination,endoscopic therapy and histopathological data of patients with early gastrointestinal cancer and precancerous lesions in the Department of Digestive Medicine,affiliated Hospital of Yan’an University,were used.To analyze and compare the clinicopathological features and influencing factors before and after operation,to provide theoretical basis for the diagnosis and treatment of early cancer and precancerous lesions of digestive tract.method:From December 2013 to December 2017,the records of patients receiving endoscopic treatment and meeting the inclusion criteria were collected in the Department of Digestive Medicine,affiliated Hospital of Yan’an University.The data of 110 patients with missing data were collected.Data items include: 1)General data: sex,age,2)Clinical data: course of disease,clinical manifestations and 3)Endoscopic examination data: lesion location,endoscopic morphology of the lesion,whether there are nodules,ulcers or erosion,(4)the data of operation and the results of pathological diagnosis before and after operation: the mode of operation,the maximum diameter of tumor,the pathological diagnosis of endoscopic clamp before operation,and the pathological diagnosis of gross specimen after operation.The data of SPSS20.0 database were established,and the counting data were expressed with the rate.Chi square test was used for comparison between the groups.Logistic regression analysis was used for multivariate analysis,and P<0.05 showed that the difference was statistically significant.Result:1.Among 110 patients with early gastrointestinal cancer and precancerous lesions,74 males(67.3%)and 36 females(32.7%)had a male to female ratio of 2.1: 1.The age distribution of the disease was 22 ~ 82 years with an average age of 60.5 ±11.3 years,and the peak age was 60-69 years old.2.Course of disease: the shortest is 3 days,the longest is more than 20 years.The main clinical manifestations were abdominal pain,abdominal distention,and severe cases could be characterized by abscess and blood stool.9 cases of defecation pain were found by physical examination,all of them were male,middle aged male accounted for33.3%,aged male accounted for 66.7%.3.The lesions were located in 11 cases of esophagus,62 cases of stomach and 48 cases of colon and rectum,respectively.The lesions were located in the upper esophagus(n = 2),the middle esophagus(n = 9),the cardia(n = 10),the fundus(n = 1),the fundus(n = 10),the fundus(n = 1),the body of stomach(n = 15),the gastric body(n = 15),the horn(n = 7),the antrum(n = 30),the ascending colon(n = 10),the transverse colon(n =4),the descending colon(n = 3),the sigmoid colon(n = 13.2),the rectum(n = 1).In 3cases,10.7%.The endoscopic morphology of the lesions was as follows: protruding type(81 cases),flat type(30 cases),concave type(10 cases)with 66.9%,flat type(30 cases)and concave type(10 cases).4.The main methods of ER operation in our hospital included endoscopic mucosal dissection and endoscopic mucosal resection.111 patients underwent ESD operation,and10 patients underwent EMR operation.ESD was performed in 62 cases of intragastric lesions and EMR in 9 cases.5.Histopathologic diagnosis: Low-grade intraepithelial neoplasms were found in42 cases,high grade intraepithelial neoplasms in 26 cases(21.5%),early carcinoma in31 cases(25.6%),invasive carcinoma in 22 cases(18.2%).There were 5 cases of LGIN in young patients and 17 cases of LGIN in middle-aged patients.There were 21 cases of early cancer in elderly patients.The diameter of lesions > 3 cm,erosion or ulcer,rough surface and concave lesions,postoperative pathological diagnosis results increased therisk of malignancy(P < 0.05).6.The coincidence rate between preoperative biopsy and postoperative pathological diagnosis was 43.0% and 52 / 121%.There was significant difference in pathological diagnosis before and after operation(P < 0.05).The diameter of the lesion was more than 3 cm and the preoperative biopsy of HGIN was a risk factor for the consistency of pathological diagnosis before and after operation(P < 0.05).Conclusion:1.In this series of cases,early and precancerous lesions of the digestive tract were better than those in men over 60 years old,and some patients were asymptomatic.2.Concave lesions with ulceration or erosion,rough surface,maximum diameter ≥3 cm,pathological diagnosis results are often higher malignant degree.3.The agreement rate between preoperative endoscopic clamp biopsy and endoscopic biopsy of gross specimens after endoscopic therapy was 43.0%,which could not be completely dependent on the results of endoscopic clamp biopsy.4.Pathological diameter ≥ 3cm was the main risk factor for the consistency of pathological diagnosis before and after operation.5.Endoscopic resection can be used either as a means of treatment or as a means of diagnosis.Biopsy and pathology indicate that the lesions with low grade intraepithelial neoplasia or more malignant degree can be resected and treated by endoscope,and the purpose of treatment can be achieved by definite diagnosis at the same time. |
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