胃黏膜上皮内瘤变370例转归及胃癌筛查的研究

A follow-up study of 370 patients with gastric intraepithelial neoplasias and cancer screening

目的探讨胃黏膜上皮内瘤变的随访对策及临床转归，分析其中胃癌筛查情况及对胃癌早期诊断的价值。方法收集2009年1月至2011年12月间瑞金医院消化专病门诊370例经胃镜活检病理证实的胃黏膜上皮内瘤变患者的临床资料，并进行定期随访及内镜复查，符合指征者行内镜或外科手术治疗及病理学检查，了解其转归及胃癌筛查情况。结果370例胃黏膜上皮内瘤变病灶主要位于远端胃（81．62％），低级别上皮内瘤变（LGIEN）组290例病灶镜下主要表现为粗糙糜烂（29．31％）及多发增生（23．45％），高级别上皮内瘤变（HGIEN）组80例病灶则以溃疡凹陷为主（58．57％）。LGIEN组最终随访结果为消退者186例（64．14％），检出HGIEN8例（2．76％）及胃癌26例（8．97％）。HGIEN组最终随访结果消退16例（20．00％），LGIEN18例（22．50％），维持HGIEN12例（15．00％），检出胃癌34例（42．50％）。不同病灶形态间转归情况具有显著差异。HGIEN组胃癌检出率显著高于LGIEN组（P〈0．0001），且两组检出率均显著高于同期普通人群。其中符合内镜下漏诊或可疑漏诊者19例，漏诊或可疑漏诊率达31．67％。结论胃黏膜上皮内瘤变的患者定期胃镜随访有望早期检出胃癌病灶，部分胃黏膜上皮内瘤变同时存有癌灶，应尤其重内镜下凹陷型病灶及活检病理为HGIEN患者的随访，内镜短期、重复检查可减少胃癌漏诊率。

Objective To explore the outcomes and gastric cancer screening within gastric intraepi- thelial neoplasia patients. Methods Data of 370 patients with gastric intraepithelial neoplasia （IEN） con- firmed by endoscopic biopsy in digestive clinic in Ruijin Hospital were coUected. All subjects received regu- lar follow-ups and endoscopic reviews to monitor the outcomes and to study the incidence of gastric cancer misdiagnosis. Results The intraepithelial neoplasia lesions were mainly located in the low part of stomach （81.62%）. The endoscopic features of 290 cases of LGIEN were erosion （29. 31% ） and multiple hyperpla- sia lesions （23.45%）, while that of HGIEN group was ulcerations （58. 57% ）. In the LGIEN group, there were 186 cases （64. 14% ） of regression, 8 cases （2. 76% ） of HGIEN and 26 cases （8. 97% ） of gastric cancer at the end of the research. In the I-IGIEN group, only 16 cases （20. 00% ） were regression, 18 cases （22. 50% ） of LGIEN, 12 cases （15.00%） HGIEN, and 34 others （42. 50% ） of cancer, which were far more than those of LGIEN group （P 〈 0. 0001 ）. The detection rates of gastric cancer of both groups were significantly higher than the general population. There were 19 cases among all the confirmed cancer patients misdiagnosed or possibly misdiagnosed. The rate of misdiagnosis or suspected misdiagnosis was 31.67%. Conclusion Patients with intraepithelial neoplasia diagnosed by endoscopic biopsy might have cancer. Close and standardized endoscopic follow-ups must be carried out timely in order to reduce the incidence of missed gastric cancer, especially for patients with ulcerative lesions or HGIEN confirmed with biopsy.