胃黏膜不典型增生和肠化生的内镜监测评价

The appreciation of endoscope detection of stomach mucosa non-typical proliferation and intestinal metaplasia

目的研究胃黏膜不典型增生及肠化生的内镜病理检出情况,并对部分病例进行长期随访,研究其转归情况及其与胃癌的关系,阐明内镜结合病理随访对胃癌早期发现的重要意义。方法对183960例行内镜检查的患者进行回顾性研究,探讨胃黏膜不典型增生及肠化生的内镜检出情况,对105例经内镜和病理诊断为胃黏膜不典型增生和肠化生的患者进行长达9年的连续内镜随访,分析其转归及癌变的情况。结果胃黏膜不典型增生及肠化生内镜总检出率是5.19%,其中不典型增生、肠化生的总检出率分别是3.37%、3.86%,且不同年龄组之间的检出情况比较P<0.05。105例胃黏膜不典型增生或肠化生患者的随访结果发现轻度不典型增生及肠化生的癌变率分别是2.27%、4.26%,重度不典型增生及肠化生的癌变率分别是25.00%、9.09%,中度不典型增生及肠化生的癌变率介于两者之间,不同程度的病变之间的比较P<0.05。结论不同程度的不典型增生及肠化生均有一定的癌变潜力,内镜结合病理检查是胃黏膜不典型增生及肠化生必不可缺的手段,对不同程度的不典型增生或肠化生进行密切的随访,可以达到胃癌的早期发现及早期治疗。

Objective To study the endoscopic detection of stomach mucosa with non-typical proliferation and intestinal metaplasia, choosing some samples that undertake endoscopy regularly to take long-time follow-up, to assess the relationship of their natural turnover and the stomach cancer. To elucidate the impordant meaning of endoscopy combined pathology examination in detecting gastric cancer earlier. Methods The history of 183 960 of patients by endoscopic biopsy was reviewed. The 9 years follow-up study was carried out for 105 cases with non-typical proliferation and intestinal metaplasia confirmed by gastroscopy and pathology. Results The total detection rate of non-typical proliferation and intestinal metaplasia was 5.19%. And the total detection rates of non-typical proliferation and intestinal metaplasia were 3.37% ,3.86% respectively. The P value of comparison of different ages was smaller than 0.05. The canceration rates of mild non-typical proliferation and intestinal metaplasia were 2.27% ,4.26% respectively. The severe non-typical proliferation and intestinal metaplasia were 25.00% ,9.09% respectively. And the moderate non-typical proliferation and intestinal metaplasia was among the two different degree process. The P value of comparison of different degree processes was smaller than 0.05. Conclusion There is cancerization in any degree for gastric epithelium non-typical proliferation and intestinal metaplasia . And carcinomatous evolution of gastric epithelium non-typical proliferation and intestinal metaplasia increases proportionally with its histological grade. Gastroscopy and biopsy are the essential means of detection of gastric cancer earlier.