胃镜下糜烂性病变的病理学探讨

Pathological Analysis of Erosive Focus Under Gastroscopy

目的 分析胃镜下表现为胃食管贲门糜烂性病变的病理组织学改变，指导胃镜下取活检指征，探讨貌似糜烂性炎性病变是否均必须作病理组织学检查。方法 回顾性总结2005年我院胃镜下诊断为食管胃中-重度糜烂性病变247例所作的病理组织学诊断，部分结合手术后病理。分析其与年龄、病变部位及内镜下表现之间的关系。结果 247例中，浅表性炎94例；含有癌前病变者（萎缩、肠上皮化生或不典型增生）123例；癌30例（早期癌23例）。其中癌及癌前病变占61．9％（153／247例）。45岁以上者癌及癌前病变占68．6％，55～65岁之间癌检出率最高（22．6％）。结论 提示无论患者年龄大小及病变部位不同最好均要做病理组织学检查。尤其是要重视55～65岁之间、病变位于高位胃体以上的患者。

Objective To estimate necessity of biopsy by analyzing histopathological diagnosis of upper gastrointestinal tract erosive focus. Methods We investigate follow up records of 247 erosive focus of upper gastrointestinal tract in gastroscopy in 2005. In which to analyze relationship of histopathological diagnosis with age, erosive location and manifestation under gastroscopy. Portion combine with postoperative histopathology. Results Among 247 cases,94 patients showed superficial inflammation, 123 patients with precancerous focus（ including atrophy, intestinal metaplasia and dysplasia） ,and 30 patients with cancer（ early cancer in 23 ）. In which cancer and precancerous lesions account for 61.9% （ 153/247 ）. The patients with cancer or precancerous focus in age of more than 45 occupy 68.6% （140/204）. It is much more than the patients in age of less than 45 （30. 2% ）. Detected rate of cancer in 55～65 years of age is the highest（22. 6% ） （21/93）. Conclusion we suggest to do biopsy in all patients best, and must do for patients in age of more than 45, especially for ages of 55～65 and lesions above gastric body. Key words：