放大内镜下胃黏膜微细结构形态与黏膜组织学改变的相关性研究

Relationship between histopathologic findings and mucosal microstructural changes under magnifying endoscopy

目的研究放大内镜下胃黏膜微细结构形态与组织学改变的关系,探讨放大内镜用于诊断萎缩性胃炎、癌前病变的可能性。方法对150例不同胃病患者,用Fujinon EG590ZW型放大内镜进行观察和分型,并在所观察的部位取活组织作病理组织学检查,研究两者之间的相互关系。结果在放大内镜下,胃小凹形态可分为A型（圆点状）、B型（短小棒状）、C型（树枝或条纹状）、D型（斑片或网格状）及E型（绒毛状）五种基本类型。A、B、C、D和E五型分别见于从正常到萎缩、肠化生和异型增生的胃黏膜,并与慢性炎症及肠化生的程度明显相关,异型增生主要见于E型和D型黏膜。结论放大内镜下胃黏膜微细结构形态与病理组织学改变存在密切关系,放大内镜对胃黏膜萎缩、肠化生及异型增生均具有重要的诊断价值。

Objective To study the usefulness of magnifying endoscopy for the diagnosis of chronic atrophic gastritis, intestinal metaplasia and dysplasia. Methods A total of 150 patients scheduled to undergo routine endoscopic examination were enrolled. After routine endoscopic examination, 2 -3 sites in the stomach were studied by magnified observation. Biopsies were taken from mag- nified sites. The microstruetures of gastric mucosa were compared with the results of pathological study. Results The morphology of gastric pits was classified as follows： type A （round spot）, type B （short rod ）, type C （branched）, type D （patchy）, and type E （villous）. Types A, B, C, D, and E were found from normal gastric mucosa to mueosa with atrophy, intestinal metaplasia and dyspla- sia, respectively, and the positive correlation was found between types A, B, C, D, E and the degree of chronic gastritis or intestinal metaplasia. Dysplasia was mostly found in type D and type E gastric mucosa. Conclusions The microstructures of gastric mucosa were closely related to the histopathologic findings. Magnifying endoscopy is useful for the diagnosis of chronic atrophic gastritis, intestinal metaplasia, and dysplasia.