胃镜下胃息肉组织与背景胃黏膜活检标本病理变化的研究

Pathological Changes in Gastric Polyp Tissues and Its Background Mucosa under Gastroscopy

目的探讨胃镜下活检不同类型胃息肉组织与背景胃黏膜癌前病变及瘤变的关系。方法对2003～2008年胃镜检查、病理证实的1825例胃息肉进行分型并对息肉组织和背景黏膜的肠上皮化生(肠化)、异型增生和瘤变关系进行分析。结果胃息肉检出率为4.3%(1825/42003);胃底腺、增生性、腺瘤性、炎症性及并发息肉(2种息肉同时发生于同一病例)分别占62.5%(1141/1825)、32.2%(587/1825)、0.8%(14/1825)、1.7%(31/1825)和2.8%(52/1825)。增生性息肉息肉组织肠化发生率(5.3%,31/587)和异型增生发生率(6.8%,40/587)均高于胃底腺息肉(0.2%,2/1141;0.4%,4/1141)(均P<0.001)。增生性息肉息肉组织癌变率为0.3%(2/587),其余类型息肉组织未发现癌变病例。息肉组织与背景胃黏膜病理变化对比分析,各型息肉病例的背景胃黏膜肠化发生率均显著高于相应息肉组织(均P<0.05),并且胃底腺息肉、增生性息肉和炎症性息肉病例的背景胃黏膜肠化程度重于息肉组织(均P<0.05)。胃底腺息肉病例的背景胃黏膜异型增生发生率显著高于息肉组织(P=0.000),且背景胃黏膜异型增生程度重于息肉组织(P=0.000)。息肉病例背景胃黏膜瘤变率(0.5%,7/1355)高于息肉组织(0.1%,2/1773),胃底腺息肉、增生性息肉和腺瘤性息肉病例的背景胃黏膜瘤变病例数分别为3例、1例和3例。结论胃息肉检出率较低;增生性息肉的息肉组织可以发生癌变;息肉背景胃黏膜存在癌前病变及瘤变,内镜检查时应重视对息肉背景胃黏膜的检查。

Objective To investigate the relationship between the pathology of gastric polyp tissues and the precancerous and malignant transformations of its background mucosa by endoscopic biopsy. Methods From 2003 to 2008, 1825 patients were diagnosed with gastric polyps in our hospital by gastroscopy and pathological examination. We classified the lesions and then analyzed the relationship between pathological changes of gastric polyp tissues and the precancerous and malignant transformations of its background mucosa by endoscopic biopsy. Results In this study, the detection rate of gastric polyps was 4.3% （ 1825/42 003 ）. The lesions included fundic gland polyps （FGP, 62.5%, 1141/1825 ）, hyperplasia polyps （HPP, 32.2%, 587/1825）, adenoma （0. 8% , 14/1825 ） , inflammatory polyps （ IP, 1.7% , 31/1825 ） , and coincident polyps （ two types of polyps were found in one case, 2.8%, 52/1825）. The rates of intestinal metaplasia （IM, 5.3%, 31/587） and dysplasia （6.8%, 40/587） in HPP tissue were higher than those in FGP tissues （0.2% , 2/1141 and 0.4% , 4/1141, P 〈 0. 001 ）. The rate of carcinoma in HPP tissue was 0.3% （2/587） , no carcinoma was detected in other types of polyp. As shown in pathological analysis of the background mueosa, the rates of IM in the background mucosa of all types of gastric polyps were higher than those in polyp tissues （ P 〈 0. 05） , and the IM in the background mucosa was more severe than that in polyps tissue in FGP, HPP and IP cases （P 〈 0. 05 ）. The rates of dysplasia in the background mucosa of FGP and adenoma cases were higher than those in polyps tissues （P = 0. 000） , and the dysplasia in the background mucosa was more severe than that in polyp tissues in FGP and adenoma cases （ P = 0. 000）. The rate of malignant transformation in background mucosa （0.5% , 7/1355） was higher than that in polyp tissues （0.1% , 2/1773）. There were three, one, and three cases of malignant transformation of the background mucosa respectively in FGP, HPP and adenoma cases. Conclusions The incidence of gastric polyps is low. In various types of polyps, malignant transformation may be detected in HPP. Whereas, both precancerous lesions and malignant transformation are detectable in background mucosa of different types of polyps.Therefore, it is necessary to carry out endoscopic biopsy of the background mucosa.