胃多发息肉内镜与病理学特征分析

Endoscopic and pathological features of multiple gastric polyps

目的分析胃多发息肉的内镜及病理学特征。方法收集2006年12月至2017年3月在青岛市市立医院消化内镜中心确诊的胃多发息肉患者1 639例,以单发息肉患者2 876例作为对照组,分析两组患者年龄、性别、内镜下表现、病理学分型、幽门螺杆菌(H.pylori)感染和息肉背景胃黏膜病理学改变。结果胃多发息肉组的内镜检出率为1.5%,低于单发息肉组(2.6%)。胃多发息肉组男女性别比为1∶3,与单发息肉组(1∶1.8)相比,胃多发息肉组女性检出率明显升高,差异有统计学意义(P<0.001)。胃多发息肉组与单发息肉组一致,均好发于胃底腺区(81.2%、65.9%);病理类型以胃底腺息肉(64.0%、60.2%)为主;息肉背景胃黏膜的病理学改变以浅表性胃炎(75.5%、71.1%)为主。胃多发息肉组的H.pylori感染率(12.3%)低于单发息肉组(25.6%)。胃多发息肉组存在并发息肉(两种及两种以上不同病理类型的息肉发生于同一病例) 97例(8.2%,97/1 179),包括增生性息肉合并胃底腺息肉81例(85.6%,83/97),增生性息肉合并腺瘤11例(11.3%,11/97)。多发胃底腺息肉与多发增生性息肉的主要发生部位均在胃底腺区(96.8%、62.4%),而多发腺瘤的主要发生部位在胃窦腺区(75.0%)。各病理类型的背景胃黏膜改变均以浅表性胃炎为主(79.8%、67.6%、62.5%)。结论胃多发息肉与单发息肉的内镜及病理学特征无显著性差异,提示二者发病原因可能相同;胃多发息肉存在并发息肉,建议医师多点、多次活检。

Objective To analyze the endoscopic and pathological features of multiple gastric polyps.Methods Patients were enrolled in the study who underwent endoscopy examination in Qingdao Municipal Hospital from Dec.2006 to Mar.2017.A total of 1 639 patients with multiple gastric polyps were included.The control group included 2 876 patients with single gastric polyps.The age,gender,endoscopic characteristics,pathological types,H.pylori status and pathological changes of surrounding mucosa were analyzed.Results The detection rate of the multiple polyps group(1.5%) was lower than that of the control group(2.6%).The ratio of male to female was 1∶3,and the detection rate of female in the multiple polyps group was significantly higher than control group(P<0.001).Polyps were most frequently detected in the region of fundic gland in two groups(81.2%,65.9%).The most frequent histological types were fundic gland polyps(64.0%,60.2%).The chronic superficial gastritis was detected in surrounding gastric mucosa of 75.5% in the multiple polyps group,which was similar to the control group(71.1%).The prevalence of H.pylori infection in the multiple polyps group(12.3%) was lower than that in control group(25.6%,P<0.001).Coincident polyps(two types of polyps found in one case) accounted for 8.2% in the multiple polyps group,including hyperplastic polyps and fundic gland polyps(85.6%),fundic gland polyps and adenomas(11.3%).The most common locations of multiple fundic gland polyps and multiple hyperplastic polyps were gastric fundus(96.8%,62.4%),The most common location of multiple adenomas was gastric antrum(75.0%).The chronic superficial gastritis in surrounding gastric mucosa was most common in the three histological types(79.8%,67.6%,62.5%).Conclusion There is no significant difference in endoscopic appearance and histological characteristics between multiple gastric polyps and single gastric polyps,suggesting a common way in the occurrence of them.A high detection rate of coincident polyps in multiple gastric polyps indicates the need for multiple biopsies in the practice.