放大胃镜对胃黏膜隆起病变定性诊断的临床研究

Clinical research of magnification endoscopy for the qualitative diagnosis of uplift of gastric mucosa lesion

目的通过比较分析放大胃镜和普通胃镜下胃癌及癌前病变的胃黏膜病变的形态特征,评价放大胃镜对胃黏膜隆起病变定性诊断的临床价值。方法将2014年3月-2015年3月符合要求的291例患者分成两组。其中,148例行放大胃镜检查,观察胃小凹及微血管形态,指导靶向活检;143例行普通胃镜下的常规黏膜活检。结果放大胃镜组检出胃黏膜上皮内瘤变25例(16.9%),其中高级别瘤变1例(0.7%),早期胃癌5例,早期胃癌检出率3.4%,总的胃癌及癌前病变的检出率20.3%;与普通胃镜组比较差异具有统计学意义(P<0.05);癌变胃小凹分型为Ⅲ、Ⅳ、Ⅴ型;微血管形态主要为C型和D型。结论放大胃镜有助于发现早期胃癌及癌前病变。

[ Objective ] By comparing detection rates of gastric cancer and precancerous lesions between amplification gastroscope and ordinary gastroscope, analysis on amplification characteristics of micro-endoscopic gastric mucosa and laws, evaluate the clinic value of magnification endoscopy for the qualitative diagnosis of uplift of gastric mucosa lesion. [Methods] 291 patients during March 2014 and March 2015 who met the requirements were ran- domly divided into two groups. Of these, 148 patients were detected with magnification endoscopy to observe gastric pits form and guiding target biopsy .Their specimens were sent to pathologic examination; Other 143 patients were undertaken ordinary endoscopic mucosal biopsy. Their specimens were sent to histological examination. [Results] Magnification endoscopy group found 71 cases of mucosa chronic inflammation, 47 （31.8%） cases of intestinal meta- plasia （31.8%）, 25 （16.9%） cases of intraepithelial neoplasia （24 cases of low-level intraepithelial neoplasia, 1 cases of high-level intraepithelial neoplasia）, 5 cases of early gastric cancer. Overall detection rate of gastric carcinoma and precancerous lesions was 20.3%; differences of mncosa chronic inflammation and lower-level intraepithelial neo- plasia rate between two groups were statistically significant （P 〈 0.05）. Gastric pit of precancerous lesions were divid- ed into typeiii, iv, V; Cancerous gastric pit were divided into type iii, iv, V （P 〈 0.01）. In micro-vascular-type A and type B, histopathological types mainly in mucosa of chronic inflammation and intestinal metaplasia, early gastric carcinoma and intraepithelial neoplasia occurred in c-type and d-type vessels （P 〈 0.05）; Micro-mucous membrane phase rule prompt high-level intraepithelial neoplasia and early gastric cancer showed ii c, iii d, iV c and iV d the four micro-Mucosa （P 〈 0.05）. [ Conclusions ] Magnification endoscopy in the diagnosis of early gastric carcinoma and precancerous lesions is superior to general endoscopy, magnification endoscopy is helpful to diagnose early gastric cancer and precancerous lesions. Characteristics of gastric micro-mucosa is helpful to set a diagnostic criteria of magnifying endoscopy for uplift of gastric mucosa lesion.