胃黏膜低级别上皮内瘤变的临床病理及转归
Clinical pathologic features of low-grade intraepithelial neoplasia and its turnover
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摘要: 目的 探讨胃黏膜低级别上皮内瘤变(LGIN)的临床病理特点及转归。方法 对2000-2010年经我院内镜检查102 193例患者进行回顾性分析,探讨胃黏膜上皮内瘤变的内镜检出率及临床病理情况,其中对346例经内镜和病理诊断为胃黏膜低级别上皮内瘤变的患者经过1-10年连续内镜随访,研究其转归及癌变情况。结果 胃黏膜上皮内瘤变(GIN)的内镜总检出率1.75%,其中LGIN检出率1.1%(346/102 193),病变等级与年龄无相关性(P>0.05);低级别上皮内瘤变中胃角部肠化阳性率较高,与其他部位比较差异有统计学意义(P<0.05);不同部位LGIN癌变率差异有统计学意义(P<0.05),且贲门部较高。随访346例LGIN,不同病理分级:轻度消失率和癌变率分别是78.7%、0.45%;轻-中度的消失率和癌变率分别是60.5%,10.5%;中度的消失率和癌变率分别是51.0%,14.3%(P<0.05)。结论 不同程度的LGIN均有一定的癌变潜力,内镜结合病理检查随访有利于早期胃癌的发现。Abstract: Objective To study the clinical pathologic features of low-grade gastric intraepithelial neoplasia(LGIN) and its turnover. Methods Clinical data about 102193 patients who underwent endoscopic examination from 2000 to 2010 were retrospectively analyzed.The endoscopic detection rate of LGIN and its clinical and pathologic features were studied.Of the 102 193 patients,346 were diagnosed with LGIN according to their clinical pathologic features and endoscopic findings,and followed up for 1-10 years during which the turnover and canceration of LGIN were observed. Results The total detection rate of GIN and LGIN was 1.75% and 1.1%,respectively.The pathological degree of LGIN was not related with the age of LGIN patients(P>0.05).The positive intestinal metaplasia(IM) was significantly higher at gastric angularis than at gastric antrum,corpus or cardia in patients with LGIN(P<0.05).The canceration rate was different at different sites of LGIN and significantly higher at cardia than at other sites(P<0.05).The elimination and canceration rate was 78.7% and 0.45% respectively for mild LGIN,60.5% and 10.5% respectively for mild-to-moderate LGIN,and 51.0% and 14.3% respectively for moderate LGIN(P<0.05). Conclusion Canceration occurs in different stages of LGIN.Gastroscopy in combination with pathologic examination and follow-up contribute to the early detection of gastric cancer.
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