【摘要】：目的:探討胃黏膜病灶活檢病理為上皮內(nèi)瘤變的臨床特征及漏診癌變的相關(guān)危險(xiǎn)因素分析,進(jìn)而提高胃上皮內(nèi)瘤變活檢診斷的準(zhǔn)確率。方法:回顧性收集2010年12月1日至2016年12月1日共203例術(shù)前活檢診斷為胃黏膜上皮內(nèi)瘤變住院患者的病例資料,分別統(tǒng)計(jì)性別、年齡、臨床癥狀、病灶部位、病灶大小、病灶內(nèi)鏡下形態(tài)、病灶病理類型、治療方法等指標(biāo)。結(jié)果:203例GIN患者中,男女比例為2.63:1;60歲以上的患者占66.5%;病灶位于胃竇和胃角的共占70.9%;病灶大小在1.0cm以上的占78.3%;內(nèi)鏡下分型中隆起型占21.2%,表淺型占58.6%,凹陷型占20.2%;胃粘膜萎縮率為62.1%,腸化率為52.7%,HP陽(yáng)性率為47.5%。根據(jù)活檢病理結(jié)果分為L(zhǎng)GIN組(111例)和HGIN組(92例),2組在性別(P=0.001)、病灶大小≥2.0cm(P=0.023)、內(nèi)鏡分型(P=0.001)、胃粘膜萎縮(P=0.008)、腸化(P=0.001)、HP感染(P=0.003)方面存在差異。203例患者中有149例行手術(shù)治療,術(shù)后病理證實(shí)為L(zhǎng)GIN者35例,HGIN者25例,EGC者75例,AGC者14例。根據(jù)術(shù)后病理結(jié)果分為GIN組(60例)和GC組(89例)。單因素分析提示組間存在差異的有性別(P=0.002)、吸煙(P=0.038)、飲酒(P=0.017)、病灶大小≥2.0cm(P=0.007)、潰瘍凹陷型(P=0.000)、萎縮(P=0.002)、腸化(P=0.000)、HP感染(P=0.000)。多因素Logistic回歸提示病灶大小≥ 2.0cm(OR=4.114,95%CI:1.248-13.565,P=0.020)、HP 感染(OR=3.723,95%CI:1.301-10.653,P=0.014)、潰瘍凹陷型(OR=8.899,95%CI:1.863-42.514,P=0.006)以及活檢病理診斷為HGIN(OR=14.735,95%CI:4.830-44.952,P=0.000)是活檢病理為GIN漏診癌變的危險(xiǎn)因素。結(jié)論:住院患者中,胃上皮內(nèi)瘤變易發(fā)生于大于60歲的老年男性患者,病灶主要位于胃竇和胃角,病灶大小多在1.Ocm以上,內(nèi)鏡下分型以表淺型多見,胃粘膜多伴有萎縮;活檢病理診斷為低級(jí)別上皮內(nèi)瘤變和高級(jí)別上皮內(nèi)瘤變?cè)谛詣e構(gòu)成、病灶大小≥2.0cm、病灶內(nèi)鏡下分型、粘膜萎縮、腸化、HP感染方面存在差異;對(duì)于活檢病理提示胃上皮內(nèi)瘤變的胃黏膜病灶,如病理為高級(jí)別上皮內(nèi)瘤變或病灶大小≥2.0 cm或內(nèi)鏡下形態(tài)呈潰瘍凹陷型或有HP感染,需警惕活檢漏診癌變的可能。
[Abstract]:Objective: to investigate the clinical features of intraepithelial neoplastic lesions and the risk factors related to missed diagnosis of carcinogenesis, so as to improve the accuracy of diagnosis of intraepithelial neoplastic lesions. Methods: from December 1, 2010 to December 1, 2016, 203 inpatients with gastric intraepithelial neoplasia diagnosed by preoperative biopsies were collected retrospectively. the sex, age, clinical symptoms, lesion location and lesion size were counted. Endoscopic morphology, pathological type and treatment of lesions. Results: among 203 patients with GIN, 66.5% were male to female, 70.9% were located in gastric antral and gastric horn, 78.3% were over 1.0cm in size, and 66.5% were over 60 years old, 70.9% were located in gastric antral and gastric horn, 78.3% were located in gastric antral and gastric horn, and 78.3% were over 60 years old. In endoscopic classification, protruding type accounted for 21.2%, superficial type accounted for 58.6%, concave type accounted for 20.2%, gastric mucous atrophy rate was 62.1%, intestinal rate was 52.7%, HP positive rate was 47.5%. According to the pathological results of biopsies, they were divided into LGIN group (n = 111) and HGIN group (n = 92). The two groups were divided into two groups: sex (P 鈮，

本文編號(hào)：2483018