探讨胃镜活检在胃黏膜膜病变内镜黏膜下剥离术（ESD）治疗中的价值。

选取2016年2月至2017年4月在南昌大学第一附属医院内镜中心行胃镜活检及组织病理学检查确诊为胃黏膜病变并行ESD及ESD术后病理学检查的患者85例进行回顾性研究。采用多个率的χ²检验比较不同病变部位（胃窦、胃体、胃角、贲门、胃底、幽门、残胃）、不同病理类型（低级别瘤变、高级别瘤变、早期胃癌）、不同病变大小ESD术前术后病理一致率的差异，再分别进行不同病变部位、不同病理类型以及不同病变大小的两两比较。

不同病变部位ESD术前术后病理一致率比较（66.7% vs 16.7% vs 22.2% vs 28.5% vs 50.0% vs 50.0% vs 100.0%），差异具有统计学意义（χ²=18.98，P=0.004）。胃窦部的ESD术前术后胃镜活检诊断一致率高达66.7%（30/45），高于胃角部22.2%（2/9）和胃体部16.7%（3/18），且差异具有统计学意义（χ²=10.96，P=0.001；χ²=4.434，P=0.023）；不同病理类型ESD术前术后病理诊断一致率比较（88.9% vs 40.6% vs 34.2%），差异具有统计学意义（χ²=15.384，P<0.001）。术前胃镜活检诊断早期胃癌一致率高于高级别瘤变及低级别瘤变，且差异具有统计学意义（χ²=12.115，P<0.001；χ²=9.124，P=0.001）；不同胃黏膜病变的病变大小术前术后病理一致率比较（38.5% vs 53.3% vs 53.3% vs 44.4%），差异无统计学意义（χ²=1.121，P=0.772）。35例术前低级别瘤变中，术前轻判占65.7%（23/35），其中有40.0%（14/35）术后提示早期胃癌；32例高级别瘤变中，术后提示早期胃癌的占46.9%（15/32）；总计术前轻判共占44.7%（38/85），其中76.3%（29/38）术后都是早期癌。

胃镜活检病理与ESD术后病理的一致率低，但术前病变程度低于实际病变可能性大，术前高级别瘤变患者有一定的恶变性，术前的胃镜活检对ESD指征的把握有较好的价值。

To assess the value of gastroscopic biopsy in the treatment of gastric mucosal lesions by endoscopic submucosal dissection (ESD).

Eighty-five patients with gastric mucosal lesions who underwent gastroscopic biopsy and histopathologic examination as well as ESD and postoperative pathological examination at the Endoscopy Center of the First Affiliated Hospital of Nanchang University from February 2016 to April 2017 were retrospectively studied. The chi square test was used to compare the consistent rate of pathological examinations before and after ESD for lesions with different locations (gastric antrum, gastric angle, gastric body, cardia, gastric fundus, pylorus, and residual stomach), pathological types (low grade neoplasia, high grade neoplasia, and early gastric cancer), or sizes.

The consistent rates of pathological examinations before and after ESD differed significantly for lesions with different locations (66.7%, 16.7%, 22.2%, 28.5%, 50.0%, 50.0%, and 100.0%, respectively; χ²=18.98, P=0.004). The consistent rate was significantly higher for lesions in the gastric antrum than in the gastric angle and body [66.7% (30/45) vs 22.2% (2/9), 16.7% (3/18), χ²=10.96, 4.434, P=0.001, 0.023]. The consistent rates of pathological examinations before and after ESD also differed significantly for lesions with different pathological types (88.9% vs 40.6% vs 34.2%, χ²=15.384, P<0.001). The consistent rate was significantly higher for early gastric cancer than for high grade neoplasia and low grade neoplasia (χ²=12.115, P<0.001; χ²=9.124, P=0.001). The consistent rates of pathological examinations before and after ESD were not statistically significant for lesions with different sizes (38.5% vs 53.3% vs 53.3% vs 44.4%, χ²=1.121, P=0.772). In 35 cases of preoperative low-grade neoplasia, 65.8% (23/35) were under-diagnosed preoperatively, with 40.0% (14/35) being diagnosed as early gastric cancer postoperatively. In 32 cases of high grade neoplasia, 46.9% (15/32) were suggested to be early gastric cancer postoperatively. In total, 44.7% (38/85) of lesions were under-diagnosed preoperatively, of which 76.3% (29/38) were suggested to be cancer postoperatively.

Preoperative diagnosis by gastroscopic biopsy has a low consistent rate with pathological diagnosis after ESD, and it is more likely that gastric mucosal lesions are under-diagnosed preoperatively, especially for patients preoperatively diagnosed with high grade neoplasia.