慢性萎缩性胃炎胃镜诊断与病理分析

Gastroscopy and pathological analysis of chronic atrophic gastritis

目的:分析慢性萎缩性胃炎胃镜诊断与病理诊断的结果。方法:2017年5月-2020年4月收治疑似性慢性萎缩性胃炎患者234例,实施胃镜检查后,与病理结果对比,分析胃镜诊断的价值。结果:所有患者均经胃镜诊断为慢性萎缩性胃炎,共234例;病理诊断为慢性萎缩性胃炎183例,慢性浅表性胃炎51例;其中合并肠上皮化生99例,合并异性增生24例;胃镜诊断和病理结果的符合率为78.21%。病理结果和胃镜诊断浅表性胃炎、萎缩性胃炎、肠上皮化生及异型增生的检出率比较,差异有统计学意义(P<0.05)。234例患者中,幽门螺杆菌(Hp)阳性115例(49.15%),阴性119例(50.85%);萎缩性胃炎患者中,Hp阳性93例(50.82%);肠上皮化生患者中,Hp阳性43例(43.43%);异性增生患者中,Hp阳性率为17.46%。结论:为了在根本上提升胃镜下诊断慢性萎缩性胃炎的检出率,除了要提升胃镜分辨率之外,还要增强对于胃黏膜形态的认知度。以多方位、多角度的方式观察患者胃肠黏膜形态,在必要状况下还应结合病理诊断,验证最终结果。

Objective:To analyze the results of gastroscopy and pathological in chronic atrophic gastritis.Methods:From May 2017 to April 2020,234 cases of patients with suspected chronic atrophic gastritis were enrolled,they were performed gastroscopy and the specific value was compared with the pathological results.Results:All the 234 cases were confirmed as chronic atrophic gastritis by gastroscopy.By pathological diagnosis,183 cases were confirmed as chronic atrophic gastritis and 51 cases were confirmed as chronic superficial gastritis.Among them,99 cases were complicated by intestinal metaplasia and 24 cases were complicated by heterosexual hyperplasia.The coincidence rate of gastroscopy diagnosis with pathological results was 78.21%.The detection rates of superficial gastritis,atrophic gastritis,intestinal metaplasia and dysplasia by gastroscopy was compared with that by pathological examination,the difference was statistically significant(P<0.05).Among 234 patients,115(49.15%)cases were Hp positive and 119(50.85%)cases were negative.Among atrophic gastritis patients,93(50.82%)cases were Hp positive.Among intestinal metaplasia patients,43(43.43%)cases were Hp positive.Among the heterosexual hyperplasia patients,the positive rate of Hp was 17.46%.Conclusion:In order to improve the detection rate of chronic atrophic gastritis under gastroscopy,in addition to improving the resolution of gastroscopy,we should also enhance the recognition of gastric mucosal morphology.The morphology of gastrointestinal mucosa should be observed in a multi-directional and multi-angle way and the final results should be verified by pathological diagnosis if necessary.