内镜下白醋喷洒对胃黏膜肠化的诊断价值探讨

The value of white vinegar staining in the diagnosis of gastric intestinal metaplasia

目的探讨胃镜下白醋喷洒对胃黏膜肠化诊断的价值。方法139例内镜诊断慢性萎缩性胃炎及浅表性胃炎的病例,应用1.5%白醋喷洒胃窦部黏膜,1min后观察其黏膜形态的变化并记录,同时在其改变最明显的部位靶向活检进行病理检查。结果64例病理证实萎缩性胃炎的病例中,伴肠化者35例,伴不典型增生者8例,喷洒白醋后29例伴肠化及5例伴不典型增生者白化明显,21例单纯萎缩性胃炎中6例白化明显,余未见明显白化;胃小凹以Ⅳ型改变为主,仅2例伴肠化者表现为Ⅲ型。70例浅表性胃炎中伴肠化的21例中有19例白化明显,49例不伴肠化的浅表性胃炎中3例白化明显;伴肠化者胃小凹改变主要为Ⅳ型,不伴肠化者以Ⅱ型改变为主;胃癌以Ⅵ型改变为主。胃黏膜白化的改变中,伴肠化组明显高于不伴肠化的浅表性胃炎和萎缩性胃炎,有统计学意义。结论内镜下对胃黏膜喷洒白醋,伴肠化及不典型增生的胃窦黏膜白化明显,胃小凹形态一过性发生变化,有助于指导靶向活检,可提高胃黏膜肠化及早期胃癌的诊断率。

Objective To investigate the value of white vinegar staining in the diagnosis of gastric intestinal metaplasia （IM）. Methods 139 patients with atrophic and superficial gastritis were enrolled. 1.5% white vinegar were sprayed on their antrum mucosa, while the gastric pits and ＂white effect＂ were observed. The biopsy samples were taken on the white effect sites. Results 64 cases of atrophic gastritis are confirmed pathologically, the antrum mucosa of 29/35 with IM, 5/8 with dysplasia and 6/21 without IM and dysplasia has significant ＂white effect＂. The mucosal pits of 62 patients with atrophic gastritis were type IV, 2 were type Ⅲ. 70 cases of superficial gastritis, 19/21 with IM and 3/49 without IM have obvious ＂white effect＂. The gastric pits of 19/21 with IM were type Ⅳ, 41/ 49 without IM were type Ⅱ. 4/5 patients of gastric cancer were type Ⅵ. The patients with IM were higher ＂white effect＂ than superficial gastritis and atrophic gastritis without IM and dysplasia. There were statistically significant. Conclusion Staining white vinegar on the gastric mucosa under endoscopy, the patients with IM and dysplasia has obvious ＂white effect＂, and the gastric pits can be shown clearly transiently which can guide targeted biopsy and be useful for the diagnosis of gastric intestinal metaplasia and early gastric cancer.