胃镜诊断和病理诊断萎缩性胃炎的相关性分析研究

Correlative alanysis and investigation of atrophic gastritis is diagnosed with gastroscopy and pathology

目的探讨CAG胃镜诊断与病理诊断的相关性以提高CAG的诊断率。方法对104例胃镜诊断CAG倾向和/或病理诊断CAG的病例进行分析。结果胃镜下诊断CAG倾向32例,其中24例与病理结果相符合,符合率为75%,且病理结果中-重度萎缩者占75%,伴肠化生16例,伴不典型增生12例;病理诊断CAG96例,其中胃镜诊断为CAG倾向者24例,仅占25%,其余糜烂性胃炎32例,伴肠化生18例,伴不典型增生16例;胃溃疡24例,伴肠化生13例,伴不典型增生18例;复合性溃疡8例,伴肠化生3例,伴不典型增生2例;幽门管溃疡8例,伴肠化生0例,伴不典型增生8例。CAG的HP感染率为98%。结论胃镜与病理诊断CAG的一致性较差,大部分CAG在胃镜下的特征性表现被糜烂、溃疡等病变所掩盖,对糜烂、溃疡等病变的边缘及周边黏膜(尤其对伴Hp感染者)仔细观察并活检,有助于提高胃镜CAG的诊断率。

Objective] To study the correlation of the diagnosises of the chronice atrophic gastritis(CAG) under gastroscopy and their pathologic result so as to raise the coincidence rate of diagnosis of the CAG. [Methods] 104 cases of CAG were analysesed with the methods of gastroscopy and(or) pathologic diagnosis. [Result] 32 cases of CAG were diagnosed under gastroscopy. Among them. 24 cases were similar with the pathologic result and the coincidence rate of diagnosis with endoscopy and pathology was 75%. The type of moderate to severe of pathology was 75%. 16 cases with intestinal metaplasia(IM) and 12 cases with atypical hyperplasia. 96 cases of CAG were diagnosed with the pathologic examination. Among them, 24 cases of CAG were diagnosed with gastroscopy, and the coincidence rate was only 25%. The other result was 32 cases erosive gastrive, 18 cases with IM and 16 cases with atypical hyperplasia; 24 cases gastric ulcer, 13 cases with IM and 18 cases with atypical hyperplasia; 8 cases compound ulcer, 3 cases with IM and 2 cases with atypical hyperplasia; 8 cases pyicyic channel ulcer, 0 case with IM and 8 cases with atypical hyperplasia. The HP infective rate was 98%. [Conclusion] The coincidence rate of diagnosis under gastroscopy and pathology is quite low in CAG. Most moderate to severe CAG′s special manifestation under gastroscopy were covered up by such lesion as erusion, ulcer. Observing carefully the border of erosion, ulcer and the peripheral mucosa of the lesion, undergoing biopsy on these lesion are help for raising the gastroscopic diagnosic rate.