胃黏膜活检组织病理学诊断与随访复查分析

Histopathological diagnosis and follow-up analysis of gastric mucosal biopsy

目的探讨胃黏膜活检组织病理学诊断及随访复查的意义。方法对5 748例胃镜活检标本进行详细的病理组织学观察,3 288例患者进行了随访复查。结果 5 748例胃镜活检标本中急性胃炎复查125例,其中治愈/好转112例(89.6%);变化不明显10例(8.0%);加重3例(2.4%)。慢性萎缩性胃炎复查2 430例,治愈/好转1 521例(62.6%);变化不明显737例(30.3%);加重172例(7.1%)。特殊类型胃炎复查71例,治愈/好转23例(32.3%);变化不明显42例(59.2%);加重6例(8.5%)。药物性胃炎/胃病复查94例,治愈/好转57例(60.6%);变化不明显34例(36.3%);加重2例(3.2%)。胃息肉复查183例,治愈/好转165例(90.2%);变化不明显13例(7.1%);加重5例(2.7%)。无瘤变/无异型增生复查205例,治愈/好转196例(95.6%);变化不明显6例(2.9%);加重3例(1.5%)。不确定瘤变/异型增生复查24例,治愈/好转2例(8.3%);变化不明显13例(54.2%);加重9例(37.5%)。上皮内瘤变复查156例,治愈/好转138例(88.5%);变化不明显4例(2.6%);加重13例(8.3%)。结论胃黏膜活检病理学诊断的11种病变及伴随病变建立不同时间随访复查,对提高胃癌早期诊断率、减少漏诊率和误诊率有重要意义。

Purpose To investigate the histopathological diagnosis and follow-up of gastric mucosal biopsy. Methods A detailed histopathological observation was performed on 5 748 gastroscopic biopsies and 3 288 patients were followed up. Resuits In 5 748 cases of endoscopy biopsy specimens, acute gastritis was rechecked in 125 cases, of which 112 cases were cured or improved （89.6%）, 10 cases （8.0%） had little change, and 3 cases （2. 4% ） were aggravated. There were 2 430 cases of chronic atrophic gastritis, in which 1521 cases were cured/improvement （62. 6% ）, 737 cases （30. 3% ） had little change, and 172 cases （7.1%） were aggravated. In the 71 cases of special type of gastritis, 23 cases were cured or improved, accounting for 32. 3%. 42 cases were not changed much, accounting for 59.2%, and 6 cases were aggravated （8.5%）.About drug-induced gastritis/stomach reexamination in 94 cases, 57 cases were cured/improved, accounting for 60. 6%, 34 （36. 3%）cases did not change, and 2 cases were aggravated （3.2%）. 183 cases of gastric polyp were reviewed, 165 cases （90. 2% ） were cured / improved, 13 cases（7. 1% ） were not changed and 5 cases（2.7% ） were aggravated. No neoplasia/ non-dysplasia was found in 205 cases, 196（95.6% ） cases was cured/improved, no change was seen in 6 cases （2. 9% ） and aggravation was seen in 3 cases （1.5%）. Indefinite neoplasia/ dysplasia was reexamined in 24 cases, 2 cases （8.3%） were cured/improved, no change was seen in 13 cases （54. 2% ）,and aggravation was seen in 9 cases（37.5% ）. 156 cases of intraepithelial neoplasia were retrospectively reviewed, in which 138 （88.5%） cases were cured or improved, 4（2.6% ） cases showed no change, and 13 （8.3%） cases were aggravated. Conclusion It is of great significance to improve the early diagnosis rate, reduce missed diagnosis rate and misdiagnosis rate of gastric cancer by establishing 11 pathological changes and accompanying lesions.