胃粘膜异型增生54例临床病理学回顾性研究

Clinicopathological retrospective study of gastric epithelial dysplasia in 54 cases

目的 通过对胃粘膜上皮异型增生（ｇａｓｔｒｉｃ ｅｐｉｔｈｅｌｉａｌ ｄｙｓｐｌａｓｉａ，ＧＥＤ）的内镜描述、病理组织学分级、不同治疗方法和癌变的回顾性研究，使内镜表现与组织学形态有机结合，为病理和临床医生制定规范统一的ＧＥＤ描述术语和诊断分级标准，为ＧＥＤ的治疗方法和预后判断提供客观依据。方法 选取５４例具有随访资料的ＧＥＤ病例，进行ＨＥ、Ｇｏｄｅｎ－Ｓｗｅｅｔ网染、Ｐ５３和ＣＥＡ免疫组化染色，观察内镜形态、组织学分级和治疗方法与癌变的关系。结果 高度ＧＥＤ内镜形态表现为褪色和灰白色，光泽消失，质地变硬且弹性差，呈平坦凹陷或平坦凸起伴浅表糜烂并且大于０．５ｃｍ，与癌变关系非常密切（Ｐ＜０．０５）。低度ＧＥＤ多为隆起型，与增生性息肉和萎缩性胃炎难鉴别。结论 低度异型增生（ｌｏｗ ｇｒａｄｅ ｄｙｓｐｌａｓｉａ）应当密切随访，或做内镜局部粘膜病灶切除后随访。高度异型增生应做内镜局部粘膜病灶切除或胃部分切除后密切随访。

Objective To study the relation between endoscopic describing, histological classification, various treatment methods of CED and cancer-transformation. Setting up a regular and united endoscopic description, pathological diagnosis and histological grading standard of CED, in which combined endoscopic appearance with histological features, to provide objective evidences for pathologists and clinician in predicting prognosis and selecting effective treatment of CED. Method HE and Goden Sweet reticular staining. 54 cases of CEO who had follow - up informations were performin . in additional, immunoreactive stainings were done by using anti - p53and anti - CEA antibodies. Results The size of high grade CED was more than 0. 5cm. Its endoscopic features showed not only decoloration or graywhite dullness, hard texture with poor elasticity, but also flat depressing or protrusion accompanied superficial erosion. The high grade CED is closely related to canceration( P <0. 05) . Whereas, the low grade CED showed mostly protrusive appearance, was very difficult to differ from hyperplastic polyps and chronic atrophic gastritis. Conclusion Low grade dysplasia must be followed-up or endoscopic all resected. High grade dysplasia must be resection under endoscopy or by gastrectomy, and then follow-up closely.