胃腺瘤性息肉的内镜和病理特点及癌变的危险因素分析

Analysis of endoscopic and pathological features of gastric adenomatous polyps and risk factors for canceration

目的:分析胃腺瘤性息肉的内镜和病理特点,探讨其癌变的危险因素。方法:回顾性总结北京大学第三医院2005年1月1日至2019年12月31日的胃腺瘤性息肉患者的内镜和病理特点,并分析癌变的危险因素。结果:共纳入胃腺瘤性息肉患者125例,女性占51.20%,平均年龄为(66.7±12.3)岁,≥65岁的患者占64.80%,<45岁者仅占5.60%。腺瘤性息肉多分布在胃体和胃窦,分别占40.80%和32.80%,以单发(90.40%)、无蒂(76.81%)为主。65.94%的腺瘤性息肉直径≤1.0 cm。23.20%(29/125)的患者合并增生性息肉和/或胃底腺息肉,其中,合并多发息肉者占58.62%(17/29),1.60%(2/125)的患者同时存在两种病理类型的息肉,1.60%(2/125)的患者伴发G1期的胃神经内分泌肿瘤。13.60%(17/125)的腺瘤性息肉患者伴发胃癌,以进展期(70.59%)、未分化型(66.67%)癌为主。伴发低级别上皮内瘤变者为18.40%(23/125)。52.80%的背景胃黏膜是慢性萎缩性胃炎伴肠化生,自身免疫性胃炎占11.20%。幽门螺杆菌的阳性率为21.60%。胃腺瘤性息肉的癌变率为20.80%(26/125),癌变以分化型为主,但有的癌变为印戒细胞癌。直径>1.0 cm(OR=5.092,95%CI:1.447~17.923,P=0.011)、表面形态不平伴有糜烂(OR=13.749,95%CI:1.072~176.339,P=0.044)是癌变的独立危险因素。结论:胃腺瘤性息肉伴发胃癌的比例高、癌变率高,直径和表面形态是癌变的独立危险因素。内镜检查时应重视内镜下息肉病理类型的鉴别,并重视全胃黏膜的评估。

Objective:To investigate the endoscopic and pathological characteristics of gastric adenomatous polyps and to assess the potential risk factors for canceration of gastric adenomatous polyps.Methods:The endoscopic and pathological characteristics of the patients with gastric adenomatous polyps from January 1,2005 to December 31,2019 were summarized retrospectively,and the risk factors of canceration were analyzed.Results:A total of 125 patients with gastric adenomatous polyps were included,51.20%of whom were females.The average age was(66.7±12.3)years.64.80%of patients with gastric adenomatous polyps equal or more than 65 years old,and only 5.60%of the patients less than 45 years old.Adenomatous polyps were mostly distributed in the corpus and antrum with 40.80%and 32.80%,respectively.The majority of them were single(90.40%)and sessile(76.81%).65.4%of adenomatous polyps were no more than 1.0 cm in diameter,and 23.20%of patients with adenomatous polyps were combined with hyperplastic polyps and/or fundus glandular polyps,and 1.60%had both pathological types of polyps.58.62%(17/29)patients with hyperplastic polyps and/or fundus glandular polyps had multiple polyps.1.60%(2/125)of the patients had gastric neuroendocrine tumor of G1 stage.Synchronous gastric cancer was detected in 13.60%(17/125)of the patients with adenomatous polyps,and the proportion of low-grade intraepithelial neoplasia was 18.40%(23/125).The main types of synchronous gastric cancer were progressive(70.59%)and undifferentiated(66.67%).Chronic atrophic gastritis with intestinal metaplasia was found in 52.80%of the patients,and autoimmune gastritis accounted for 11.20%.The positive rate of Helicobacter pylori was 21.60%.The canceration rate of gastric adenomatous polyps was 20.80%.The cancer was mainly differentiated,but there was sigmoid ring cell carcinoma as well.Diameter of>1.0 cm(OR=5.092,95%CI:1.447-17.923,P=0.011),uneven surface morphology and erosion(OR=13.749,95%CI:1.072-176.339,P=0.044)were independent risk factors of adenomatous polyps.Conclusion:The synchronous gastric cancer is common and the canceration of gastric adenomatous polyps is high with diameter and surface morphology as independent risk factors.We should pay attention to the identification of the pathological types of polyps and the evaluation of the whole gastric mucosa during the endoscopic examination.