胃黏膜上皮细胞异型增生的胃镜随访及病理分析

Endoscopy and pathology analysis of gastric epithelial cell dysplasia according to the mid-long term follow-up

目的探讨胃黏膜上皮细胞异型增生与胃癌发生的关系、演变规律。方法对189例伴有异型增生胃部病变患者用胃镜随访复查，对不同程度异型增生的变化和转归资料进行回顾性分析。结果胃镜观察189例伴异型增生的病灶主要分布在胃体和胃窦。随访时间6个月至8．3年，平均（3．41±2．53）年，随访结果异型增生消退134例占70．9％，其中，轻、中、重度异型增生消退率分别为85．7％、49．0％、36．8％，轻、中、重度异型增生消退时间分别为（1．36±0．62）、（2．54±1．85）、（2．37±1．76）年。189例胃黏膜上皮细胞异型增生患者癌变15例，癌变率为7．9％，轻、中、重度异型增生癌变率分别为1．7％、9．8％、42．1％，15例胃癌中早期胃癌6例占40．0％。结论胃黏膜上皮细胞异型增生具有不容忽视的癌变倾向，重度异型增生癌变率高，用胃镜定期随访复查可提高早期胃癌检出率，在临床工作中应普遍开展。

Objective To study the relation and evolvement rule between gastric epithelial ceUs and gastric canecer dysplasia. Method Different degrees of 189 patients with gastric epithelial ceU dysplasia in dysplasia changes and outcome from the follow-up with gastroscope reexamination were retrospectively analyzed. Results Allotype hyperplastic lesions in 189 patients mainly distributed at gastric body and sinus. The shortest follow-up time was six months, the longest was 8.3 years, and the average follow-up time was （3.41 ± 2.53 ）years. Allotype hyperplasia in 70.9% of 189 patients regressed in the end of follow-up. Among them, the regression rate of mild, medium and serious allotype hyperplasia was respectively 85.7%, 49.0%, 36.8%, and the regression time was （1.36 ±0.62）, （2.54± 1.85 ）, （2.37± 1.76）years respectively. Canceration rate was 7.9% （15 cases） in 189 patients with allotype hyperplasia. It was 1.7%, 9.8% and 42.1% respectively in patients with mild, medium and serious allotype hyperplasia. There was 40.0% （6 cases） of 15 patients with gastric cancer belonged to the early stage. Conclusions There is an innegligible tendency of canceration and higher canceration rate of serious lesions in allotype hyperplasia. So it should be paid attention to and treated intensively. The discovering rate of early gastric cancer would be improved by regular follow-up with endoscopy review practicing in clinical work.