老年人胃息肉的临床特点分析

The clinical characteristics of gastric polyps in aged patients

目的 总结老年人内镜下胃息肉的形态学特征、病理特点及进行内镜下治疗疗效观察,并分析其与幽门螺旋杆菌感染、萎缩性胃炎的相关性. 方法 对2012-01-01 ～2013-12-30在我院行胃镜检查的老年患者8 436例进行回顾性分析,胃镜下确诊胃息肉患者353例,对其及对照组（慢性胃炎组和消化性溃疡组）的病理特点、H.pylori感染情况（13C-呼吸试验）等进行对照分析.316例胃息肉患者行内镜下切除,标本送病理检查,对其中65例进行随访观察,随访时间为3-12个月. 结果 老年人胃息肉患者检出率为4.18％.219例（62.04％）胃息肉患者年龄60-69岁,223例为山田Ⅰ型,58.08％息肉直径为≤0.5 cm.单发息肉229例（64.87％）,多发息肉124例（35.13％）;单发息肉较多见于胃窦部91例（25.78％）,其次为胃底部80例（22.66％）及胃体部58例（16.43％）.对316例进行病理检查,其中炎性增生性息肉、腺瘤性息肉、胃底腺息肉分别占70.14％,6.03％,23.84％.胃息肉患者中H.pylori的感染率为55.52％,萎缩性胃炎的发生率为9.81％,与慢性胃炎组和消化性溃疡组相比差异无显著性.随访65例,26例复发,其中复发26例中的17例为多发息肉治疗后复发、20例为炎性增生性息肉. 结论 老年人有较高的胃息肉检出率,单发息肉多见,并以炎性增生性息肉及胃底腺息肉较常见;H.pylori感染与炎性息肉相关;胃镜下息肉切除是安全有效的治疗手段,多发息肉治疗后可能容易复发.

Objective To summarize the morphological, pathological characteristics of gastric polyps and endoscopic treatment in the elderly, and to analyze its relationship with Helicobacter pylori infection and atrophic gastritis. Methods The clinical data of 8 436 elderly patients from January 1,2012 to December 30, 2013 in our hospital undergoing gastroscopy were retrospectively analyzed. The pathological characteristics and H. pylori infection （ 13 C-breath test） between polyp group and chronic gastritis group, peptic ulcer group were compared. A total of 316 cases of gastric polyps in patients underwent the endoscopic polyp resection, and the specimens were sent for pathological examination. Sixty-five cases were followed up for 3 - 12 months. Results A total of 353 cases（4.18% ） were diagnosed as gastric polyps. The gastric polyps were detected in 62.04% patients of 60 - 69 years old. Totally 223 cases were Yamada type I and 58.08% of polyps was less than 0.5 cm. There were 229 cases（64.87%） of single polyp and 124 cases（35.13% ）of mul- tiple polyps. Single polyp was more common in the gastric antrum（91 cases, 25.78% ）, followed by the gastric bottom（80 cases, 22.66%） and the body of the stomach （58 cases, 16.43 %）. Inflammatory proliferative polyp, adenomatous polyps and fundic gland pal- yps accounted for 70.14%, 6.03%, 23.84%, respectively. H. pylori infection rate was 55.52% in the patients with gastric polyps. The incidence of atrophic gastritis was 9.81%. A total of 65 cases were followed up and 26 cases recurred, including 17 cases of polyp re- currence after treatment and 20 cases of inflammatory proliferative polyp. Conclusion Elderly population have a higher detection rate of gastric polyps. Pathological types of inflammatory proliferative polyps and fundic gland polyps are common. H. pylori infection is as- sociated with inflammatory polyp. There is no relationship between gastric polyps and atrophic gastritis. Endoscopic polypectomy is a safe and effective therapeutic method. Multiple polyps could be easy to relapse after treatment.