2554例胃息肉病理类型与临床特征分析

Analysis of pathological types and clinical characteristics of gastric polyps in 2 554 cases

目的分析胃息肉临床、内镜及病理特征,加强临床工作中对胃息肉的认识。方法收集2012年12月至2017年12月上海交通大学医学院附属瑞金医院北院消化内科检出的胃息肉病例,共2554例,收集患者性别、年龄、内镜特征、病理结果等数据。结果所有病理类型的胃息肉均随着年龄的增长发生概率增加,≥60岁的患者中发生各病理类型的胃息肉比例最高;女性胃息肉构成比明显高于男性,差异有统计学意义(χ2=15.73,P<0.01);所有息肉中以胃体部最常见(1024例),炎性息肉、增生性息肉、腺瘤性息肉以胃体及胃窦为主,其中胃底腺息肉以胃底和胃体为主。腺瘤性息肉中巴黎0-Ip型比例较高(42.50%),随着息肉增大,炎性息肉、增生性息肉、胃底腺息肉均呈下降趋势,而腺瘤性息肉呈上升趋势。H.pylori感染共561例(21.97%),而胃底腺息肉的H.pylori感染率明显低于其他三组(3.60%)。入组患者中共有54例(2.11%)胃息肉合并上皮内瘤变,腺瘤性息肉、≥2 cm息肉中发生上皮内瘤变比例最高(比例分别为35.00%、17.86%,P值分别<0.01、<0.01)。结论高龄及女性患者胃息肉检出率高,胃底腺息肉主要分布于胃底及胃体,发生胃底腺息肉患者合并H.pylori感染概率明显下降,≥1 cm的息肉中腺瘤性息肉检出率增加,而≥2 cm的腺瘤性息肉发生上皮内瘤变概率最高,以上胃息肉的特点需在临床工作中加以认识。

Objective To analyze the clinical,endoscopic and pathological features of gastric polyps,and to enhance the understanding of gastric polyps in clinical work.Methods A total of 2554 cases of gastric polyps detected in the Department of Gastroenterology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from Dec.2012 to Dec.2017 were collected.The data of gender,age,endoscopic features and pathological findings were collected.Results The gastric polyps of different pathological types increased with age.The proportion of gastric polyps in each pathological type was the highest in patients aged 60 years or older.The incidence of gastric polyps was significantly higher in femal than that in male(χ2=15.73,P<0.01);all polyps were most common in the corpus(1024 cases),inflammatory polyps,hyperplastic polyps,adenomatous polyps mainly in the corpus and antrum,of which the fundus glandspolyps were mainly distributed in the fundus and corpus.In the adenomatous polyps,the proportion of Paris 0-Ip was higher(42.50%).As the size of polyps increased,inflammatory polyps,hyperplastic polyps,and gastric fundus polyps showed a downward trend,while adenomatous polyps showed an upward trend.There were 561 cases(21.97%)of H.pylori infection,and the H.pylori infection rate of gastric fundus polyps was significantly lower than that of the other three groups(3.60%).A total of 54 patients(2.11%)had gastric polyps combined with intraepithelial neoplasia,adenomatous polypsand≥2 cm polyps had the highest proportion of intraepithelial neoplasia(35.00%,17.86%,respectively,P values were<0.01,<0.01).Conclusion The detection rate of gastric polyps is higher in elderly and female patients.The fundus glandspolyps are mainly distributed in the fundus and corpus,and the probability of H.pylori infection in patients with gastric fundus polyps is significantly decreased.The detection rate of adenomatous polyps in polyps≥1 cm increased,and adenomatous polyps≥2 cm have the highest probability of intraepithelial neoplasia.The characteristics of the above gastric polyps need to be recognized in clinical work.