胃镜下胃息肉的临床病理分析

Clinical and pathological analysis of gastric polyps diagnosed by gastroscopy

目的 了解胃镜下胃息肉的临床及病理特点。方法 对 2年间胃镜下胃息肉进行重新分型并对息肉本身的急、慢性炎症、癌前改变、癌变以及不同类型息肉与幽门螺杆菌 (helicobacterpylori,H .pylori)的关系进行分析。结果 胃镜下胃息肉的检出率为 3.0 % ( 2 5 0 / 8319) ,男性 1.6 % ( 71/ 4 4 4 8) ,女性 4 .6 % ( 179/ 3871) ;单发和多发息肉分别占 6 6 .8%和 33.2 % ,平均 ( 2 .2± 2 .9)枚 ;2 36例进入病理分析 ,胃底腺、增生性、腺瘤及炎性纤维性息肉分别占 2 8.0 % ,2 5 .0 % ,0 .8%和 0 .4 % ,有 4 5 .3%镜下息肉病理检查无息肉组织发现(组织学阴性息肉 ) ;胃底腺 ( 3.8± 4 .8)较增生性 ( 1.7± 1.4 )和组织学阴性息肉 ( 1.4± 1.0 )多发 ;胃底腺、增生性和组织学阴性息肉本身中度以上慢性炎症分别占 0 ,6 1.0 %和 5 4 .2 % ,有中性粒细胞浸润分别为 0 %、4 0 .7%和 31.8% ,萎缩分别占 0 ,8.5 %和 12 .1% ,肠化生分别为 1.5 % ,37.3%和 17.8% ,不典型增生分别占1.5 % ,8.5 %和 3.7% ,胃窦粘膜H .pylori检出率分别为 7.6 % ,2 0 .3%和 33.6 % ,未发现癌变改变 ;胃底腺息肉全部分布在底、体部 ,增生性息肉分布于全胃 ,组织学阴性息肉分布于全胃但以胃窦多见。结论 胃息肉的检出率较低 ,女性多见 。

Objective: Investigate the clinical and pathological characteristics of gastric polyps diagnosed by gastroscopy. Methods: Reviewed our hospital's gastroscopy reports during two years (from 2000 to 2001); re-examed the pathologic presentation of gastric polyps, including the types, acute and chronic inflammation, atrophy, intestinal metaplasia, dysplasia and carcinoma and helicobacter pylori (H.pylori) infection of antral mucosa.Results:Rate of gastric polyps diagnosed by gastroscopy was 3.0%(250/8319), composed of 1.6% (71/4448) men and 4.6% (179/3871) women. Solitary polyp and multiple polyps were 66.8% and 33.2% respectively, the average was (2.2±2.9)(1～>20). Two hundred and thirty-six cases were analysed by pathology, they included 28.0% fundic gland polyps(FGP), 25.0% hyperplastic polyps(HPP), 0.8% adenoma and 0.4% inflammatory fibroid polyps; one of the patients had FGP and HPP simultaneously; remaining ( 45.3%) polyps diagnosed by gastroscopy had no polypoid tissue(non-PTP) found by pathology. The FGP had multiple trendency, the average number of FGP, HPP and non-PTP were(3.8±4.8),(1.7±1.4), (1.4±1.0) respectively. The FGP, HPP and non-PTP had moderate and severe chronic inflammation, which were 0%, 61.0%, and 54.2% respectively; correspondingly, infiltration of polymorphic nuclear granulocytes were 0%, 47.0% and 31.8% respectively; atrophy were 0%, 8.5% and 12.1% respectively; intestinal metaplasia were 1.5%, 37.3% and 17.8% respectively; dysplasia were 1.5%, 8.5% and 3.7% respectively; and H.pylori infection of antral mucosa in these patients were 7.6%, 20.3% and 33.6% respectively; no carcinoma was found. All of the FGP located in fundus and body of the stomach; the HPP dispersed in every part of the stomach; and non-PTP could be seen easily in antrum.Conclusions: The incidence of gastric polyps is low, they have female susceptibility, most of them are solitary. Gastric polyps in gastroscopy mainly consist of FGP, HPP and non-PTP. The FGP locate in fundus and corpus, however HPP disperse in stomach. Acute inflammation, prominent chronic inflammation, atrophy, intestinal metaplasia, dysplasia and H.pylori infection are easily seen in HPP and rarely found in FGP.