胃黏膜隆起糜烂胃小凹分类及其临床病理价值

Classification of pits in gastric protrusive erosion and its clinicopathological value

目的探讨放大内镜下胃黏膜隆起糜烂胃小凹的形态学分类及其临床病理价值。方法应用Olympus GIF—Q24OZ型电子放大内镜结合美蓝染色,对151例胃炎伴隆起糜烂的患者进行胃黏膜细微结构形态学观察,将糜烂胃黏膜小凹的形态改变分为:A型(圆点状)、B型(短小棒状)、C型(稀疏而粗大的线状)、D型(斑块状)、E型(绒毛状)及F型(小凹结构模糊不清、消失)6型,并与放大观察部位活检所得组织的病理组织学改变进行了比较分析。结果A、B2型胃小凹主要见于正常胃黏膜,而C、D、E和F4型分别见于活动性、萎缩性、肠上皮化生及轻、中度异型增生的胃黏膜,其特征性改变与慢性炎症程度具有明显正相关,亦代表着胃黏膜病变的不同阶段,而肠上皮化生及异型增生主要见于D、E和F型。放大内镜对胃黏膜隆起糜烂萎缩性、肠上皮化生及异型增生镜下诊断的符合率分别为83.51%、79.41%及87.50%。结论6种胃小凹形态与其病理组织学存在明显相关性,在放大内镜结合黏膜染色下准确识别胃小凹的形态,将有助于对萎缩、肠化生及异型增生等胃黏膜病变的镜下诊断。

[Objective] To explore the classification of pits in gastric protrusive erosion under magnifying endoscopy and its clinicopathological value. [Methods] Microstructures of gastric mucosa in 151 patients with gastric protrusive erosion were studied using Olympus GIF-Q240Z magnifying endoscope and stained with methylene blue. Magnifying endoscopic patterns of gastric protrusive erosion pits were classified into six types：type A （round spot pits）, types B （short rod pits）, type C （sparsely and thickly linear）, type D （patchy）, type E （villous） and type F （un- clear or disappearances of pits）. Specimens were taken from the magnified sites and the results of histopathological biopsy were regarded as gold standard. [Results] Types A, B were found in normal gastric mucosa, and types C, D, E, F were found in gastric mucosa from active, atrophic, intestinal metaplasia and dysplasia respectively. It had a positive correlation between six types and the degree of gastric mucosal lesions, and intestinal metaplasia and dysplasia were found mostly in gastric mucosa with D, E and F microstructures under magnifying endoscopy. The accuracy of diagnosis under magnifying endoscopy in gastric protrusive erosion mucosa with atrophy,intestinal metaplasia and dysplasia were 83.51%, 79.41% and 87.50% respectively. [Conclusion] There is a positive correlation between six types and their clinicopathological results. The identification of gastric pits under magnifying endoscope combined with methylene blue staining would help the diagnosis of gastric mucosal lesions with atrophy,intestinal metaplasia and dysplasia.