慢性萎缩性胃炎的胃镜与病理诊断的对比分析

Comparison of chronic atrophic gastritis by endoscopy and the pathological results

目的:对胃镜下慢性萎缩性胃炎的肉眼诊断结果与黏膜活检的病理诊断结果进行对比分析,探讨二者的一致性及临床意义。方法:收集我院内镜诊治中心2013年7月至2016年7月行内镜检查的67 727例患者中,胃镜下诊断慢性萎缩性胃炎的患者2 484例,对比胃镜下肉眼诊断和黏膜活检的病理诊断的一致性。结果:拒绝送病理38例,慢性浅表性胃炎1 196例,慢性萎缩性胃炎1 250例,其中伴有肠上皮化生322例,伴有非典型增生108例,伴有上皮内瘤变218例。胃镜诊断萎缩性胃炎的准确率为50.32%,内镜下表现为黏膜粗糙不平,呈颗粒状或者结节状改变的病理符合率为32.59%。内镜下表现为黏膜粗糙不平,呈颗粒状或者结节状改变,黏膜红白相间,以白为主的病理符合率为23.40%,其符合率之间比较差异无统计学意义(P>0.05)。内镜下表现为黏膜粗糙不平,呈颗粒状或者结节状改变,黏膜红白相间,以白为主,黏膜的血管暴露并透明可见,皱襞变薄,变平或消失的病理符合率为83.77%。其符合率之间比较差异有统计学意义(P<0.05)。结论:胃镜下诊断慢性萎缩性胃炎与黏膜活检的病理诊断结果有差异,为提高准确性,应在胃镜检查时根据内镜下慢性萎缩性胃炎表现的特征性,并结合病理取材避免漏诊,达到积极预防,早期发现慢性萎缩性胃炎的目的。

Objective:To compare the results of chronic atrophic gastritis by endoscopy and the pathological results by mucosal biopsy.Explore their consistency and clinical significance.Methods:Collect 67 727 patients from July 2013 to July 2016 in the endoscopy center of our hospital.2 484 patients of 67 727 patients were chronic atrophic gastritis by endoscopy.Compare their consistency of the results of chronic atrophic gastritis by endoscopy and the pathological results by mucosal biopsy.Results:38 patients refused to do pathological diagnosis,1 196 patients of chronic superficial gastritis,1 250 patients of chronic atrophic gastritis,322 patients with intestinal metaplasia,108 patients with atypical hyperplasia,218 patients with intraepithelial neoplasia.The accuracy rate of gastroscopy in the diagnosis of atrophic gastritis was 50.32%.Endoscopic manifestations showed mucosal roughness,granular or nodular changes in the pathology coincidence rate of 32.59%.Endoscopic findings showed endoscopic mucosal roughness,granular or nodular changes,mucosal red and white,white to the main pathology of the rate of 23.40%,the coincidence rate between the difference was not statistically significant(P>0.05).Endoscopic manifestations showed mucosal roughness,granular or nodular changes,mucosal red and white,white-based,mucosal vascular exposure and transparent visible folds thinning,flatten or disappear the pathology coincidence rate of 83.77%.There was significant difference between the coincidence rates(P<0.05).Conclusion:There is difference between the results of chronic atrophic gastritis by endoscopy and the pathological results by mucosal biopsy.In order to improve the accuracy,endoscopy should combine with the chronic atrophic gastritis performance characteristics.To avoid missed diagnosis,endoscopy with mucosal biopsy can achieve the goals of active prevention and early discovery.