本文選題：胃黃色瘤 + 胃癌��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：背景與目的:胃黃色瘤的臨床意義近年來獲得越來越多的關(guān)注,黃色瘤主要發(fā)于胃部,發(fā)于食道及十二指腸部相對少見,在胃鏡下一般表現(xiàn)為黃色、白色結(jié)節(jié)樣隆起,過去一直認為是一種病因尚不十分明確的胃腸道良性病變。有研究認為胃黃色瘤是預(yù)測早期胃癌發(fā)展的標(biāo)志物。本研究目的旨在研究本院近6年來內(nèi)鏡檢查中發(fā)現(xiàn)胃黃色瘤患者與無胃黃色瘤人群相比,萎縮性胃炎等胃癌前狀態(tài)及腸上皮化生等胃癌前病變的檢出率差異及影響因素,以評估黃色瘤與萎縮性胃炎、腸上皮化生等之間的相關(guān)性。方法:選取我院2011年1月1日至2016年11月25日消化內(nèi)鏡下發(fā)現(xiàn)胃黃色瘤的患者,其中男性患者448人,女性患者426人。選取同時期來我院行胃鏡檢查共545名胃鏡下未發(fā)現(xiàn)黃色瘤患者,其中男性269人,女性276人,記錄黃色瘤部位、多發(fā)與否、患者年齡、性別等相關(guān)變量,比較胃黃色瘤患者與無黃色瘤人群中胃鏡活組織病理檢查中幽門螺旋桿菌感染、粘膜糜爛、潰瘍、萎縮性胃炎、腸上皮化生、上皮內(nèi)瘤變、胃癌等檢出率。相關(guān)黏膜損傷診斷均以內(nèi)鏡下活組織檢查為準(zhǔn)。結(jié)果:胃黃色瘤組幽門螺旋桿菌檢出率較對照組未見明顯升高,兩者胃癌檢出率亦無明顯統(tǒng)計學(xué)差異,黃色瘤組與對照組之間性別無明顯統(tǒng)計學(xué)差異。黃色瘤組年齡顯著高于對照組。黃色瘤組與對照組的腸上皮化生發(fā)生率存在顯著差異。且較于無黃色瘤的對照組,黃色瘤患者發(fā)生腸上皮化生的嚴重程度更高。類似的,黃色瘤患者中萎縮性胃炎的發(fā)生率與對照組有顯著差異,且萎縮嚴重程度更高。黃色瘤患者中,黃色瘤以單發(fā)于胃竇為主,位于不同部位黃色瘤組間胃癌檢出率無明顯差異。黃色瘤多發(fā)患者腸上皮化生及萎縮性胃炎的發(fā)生率與黃色瘤單發(fā)患者發(fā)生率無顯著差異,但是多發(fā)患者腸上皮化生及萎縮性胃炎的嚴重程度均較單發(fā)患者更高。結(jié)論:黃色瘤患者組幽門螺旋桿菌感染、胃癌等的檢出率與正常人群相比并無顯著性差異。在進一步的分析中,黃色瘤患者腸上皮化生和萎縮性胃炎的比例及其嚴重程度都顯著高于對照組。黃色瘤患者中,與單發(fā)黃色瘤患者相比,多個部位發(fā)現(xiàn)黃色瘤的患者中重度腸化比例更高。考慮到腸上皮化生為公認胃癌前病變,而萎縮性胃炎是公認胃癌前狀態(tài),內(nèi)鏡下檢出胃黃色瘤或可以作為評估病情嚴重程度的指標(biāo),內(nèi)鏡下發(fā)現(xiàn)黃色瘤的患者或許更需要行內(nèi)鏡下活檢以排除胃癌的可能。
[Abstract]:Background & objective: in recent years, more and more attention has been paid to the clinical significance of gastric xanthoma. Xanthoma mainly occurs in the stomach and is relatively rare in the esophagus and duodenum. It has long been thought of as a benign gastrointestinal disease that is not yet well-defined. Some studies suggest that xanthoma is a marker for early gastric cancer. The purpose of this study was to investigate the differences and influencing factors of gastric precancerous status such as atrophic gastritis and intestinal metaplasia in patients with gastric xanthoma in our hospital during the past 6 years. To assess the correlation between xanthoma and atrophic gastritis, intestinal metaplasia, etc. Methods: from January 1, 2011 to November 25, 2016, we selected 448 male patients and 426 female patients. A total of 545 patients (269 males and 276 females) with xanthoma, including 269 males and 276 females, were examined by gastroscopy in the same period. The location of xanthoma, multiple tumor sites, patient age, sex and other related variables were recorded. To compare the detection rates of helicobacter pylori infection, mucosal erosion, ulcer, atrophic gastritis, intestinal metaplasia, intraepithelial neoplasia and gastric cancer in patients with gastric xanthoma and those without xanthoma. The diagnosis of mucosal injury was based on endoscopic biopsy. Results: the detection rate of Helicobacter pylori in the xanthoma group was not significantly higher than that in the control group, and there was no significant difference in the detection rate of gastric cancer between the two groups, and there was no significant difference in sex between the xanthoma group and the control group. The age of xanthoma group was significantly higher than that of control group. There was significant difference in the incidence of intestinal metaplasia between the xanthoma group and the control group. The severity of intestinal metaplasia in xanthoma patients was higher than that in controls without xanthoma. Similarly, the incidence of atrophic gastritis in xanthoma patients was significantly different from that in the control group, and the severity of atrophy was higher. In xanthoma patients, xanthoma mainly occurred in the antrum, but there was no significant difference in the detection rate of gastric cancer among the xanthoma groups. There was no significant difference in the incidence of intestinal metaplasia and atrophic gastritis between multiple xanthoma patients and single xanthoma patients, but the severity of intestinal metaplasia and atrophic gastritis in multiple cases was higher than that in single cases. Conclusion: the detection rate of Helicobacter pylori infection and gastric cancer in xanthoma patients was not significantly different from that in normal controls. In further analysis, the proportion and severity of intestinal metaplasia and atrophic gastritis in xanthoma patients were significantly higher than those in the control group. In xanthoma patients, the proportion of moderate and severe intestinal metaplasia was higher in patients with xanthoma than in patients with single xanthoma. Considering that intestinal metaplasia is a recognized precancerous lesion and that atrophic gastritis is an accepted pregastric cancer condition, and that the detection of xanthoma by endoscopy may serve as an indicator of the severity of the disease, Patients with endoscopic xanthoma may be more likely to have endoscopic biopsies to rule out stomach cancer.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.2

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相關(guān)期刊論文 前2條

1 Romilda Cardin;Marika Piciocchi;Marina Bortolami;Andromachi Kotsafti;Luisa Barzon;Enrico Lavezzo;Alessandro Sinigaglia;Kryssia Isabel Rodriguez-Castro;Massimo Rugge;Fabio Farinati;;Oxidative damage in the progression of chronic liver disease to hepatocellular carcinoma:An intricate pathway[J];World Journal of Gastroenterology;2014年12期

2 Sun Young Yi;;Dyslipidemia and H pylori in gastric xanthomatosis[J];World Journal of Gastroenterology;2007年34期

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本文編號：2042763