628例胃息肉临床特点及病理特征回顾性分析

发布时间：2018-05-04 10:37

  本文选题：胃息肉 + 病理类型　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的通过收集大连医科大学附属第一医院消化内科胃息肉住院患者的临床资料与辅助检查,胃息肉在内镜下的表现以及病理结果,分析近几年胃部息肉的临床特点及针对病理类型的变化情况,为日后胃息肉的预防、诊断以及选取合适的诊疗方法提供临床参考。资料与方法1.研究对象大连医科大学附属第一医院消化内科从2014年1月到2016年12月期间住院的患者里面经胃镜探查并且完成病理活检的息肉患者病例共628人。除外胃癌、黑斑息肉病(Peutz-Jeghers综合征)、有胃部手术病史者及幼年性息肉病(Juvenile polyposis JPS)等其他情况。搜集患者个人资料、学历、居住环境、伴随其他系统疾病、相关辅助检查及胃镜和病理结果,胃镜结果需详细记录病变的部位、数目、息肉最大径(如为多发息肉则取最大者息肉的最大径)、广基或带蒂、表面黏膜情况等。其中,男性患者共有146例,占总人数的23.2%,女性患者有482例,占总人数的76.8%,男女性别比值为1:3.13。入选患者的年龄范围是21岁至86岁,本组病例的平均年龄为59.24岁。2.内镜检查均由我院专业内镜医师对受检者食管及胃部各个部位进行全面仔细观察,记录息肉的一般情况,包括所在部位、息肉最大径、隆起或扁平、数量及表面黏膜情况等。3.病理组织学检查对于单发直径小于等于3mm的胃息肉取材后直接电凝切除,大于3mm的息肉选取相应措施摘除的同时钳取小部分组织进行活检,多发性胃息肉取代表性1-2块组织进行活检,以上组织均由我院病理科得出病理诊断。4.统计学处理收集的资料经SPSS 21.0软件处理分析,计量资料以X±S或中位数表示,计数资料不同类型用x2检验进行比较,P0.05为差异有统计学意义。结果1.本研究共纳入628例患者,年龄最小21岁,最大86岁,平均年龄59.24岁。其中,女性患者和男性患者相比,发病年龄段不同,60岁的患者女性多发,≥60岁患者中男性多发,有统计学差异(X2=9.585,P=0.048)。男性占23.2%(146/628),女性占76.8%(482/628),男女比值约为1:3.301,女性占大多数。女性患者发病率与男性患者发病率相比较,女性患者在人数上明显高于男性,差异有意义(X2=628,P0.001)。2.临床症状主要有反酸(18.1%)、烧心(15.9%)、胸骨后烧灼感(或咽部梗咽感、吞咽困难)(3.7%)、消瘦、食欲不振(2%)、恶心呕吐(5.2%)、腹痛(20.9%)、腹部不适(5.6%)等。3.单发息肉为333例(53.0%),多发息肉为295例(47.0%)。胃底腺息肉最多见(49%),其次是增生性息肉(35.7%)、炎性息肉(9.1%)、腺瘤性息肉(2.1%)及炎性纤维性息肉(1.3%)。≤0.5cm胃息肉最多见,占70.9%。4.山田分型Ⅰ型有133例,占21%;Ⅱ型有472例,占75.2%;Ⅲ型有21例,占3.3%;Ⅳ型有2例,占0.3%,Ⅰ型和Ⅱ型息肉占大多数。胃底和胃体是胃息肉最好发部位,占28.8%、36.6%。结论:胃息肉患者女性多发;中老年人更多发胃息肉;胃体是息肉最常见的好发部位,其次分别是胃底、胃窦、贲门、胃角和幽门;在0.5cm的息肉最常见,≥2.0cm息肉少见;山田分型中Ⅱ型最常见;胃底腺息肉最常见,第二是增生性息肉,其他依次是炎性息肉、腺瘤性息肉、炎性纤维性息肉。胃底腺息肉多出现在胃底和胃体,增生性息肉大多数发生于胃体及胃窦部,炎性息肉于贲门和胃窦部位多发,炎性纤维性息肉主要发生在胃窦部。
[Abstract]:Objective to analyze the clinical characteristics and pathological results of gastric polyps in recent years by collecting the clinical data and auxiliary examination of the patients with gastric polyps in the digestive department of the First Affiliated Hospital of Dalian Medical University, and to analyze the clinical characteristics of gastric polyps in recent years and the changes in the pathological types. The prevention, diagnosis and selection of the gastric polyps in the future are suitable for the prevention and selection of the gastric polyps. The method of diagnosis and treatment provides clinical reference. Data and methods 1. subjects of polyp patients who were hospitalized in the first hospital of the First Affiliated Hospital of Dalian Medical University from January 2014 to December 2016 were examined by gastroscopy and completed pathological biopsy, except for gastric cancer, Peutz-Jeghers syndrome, and stomach. Other cases, such as surgical history and juvenile polyposis (Juvenile polyposis JPS). Collection of personal data, educational background, living environment, accompanied by other systemic diseases, associated examination and gastroscopy and pathological results. The results of gastroscopy require detailed records of the site, number and maximum diameter of polyps (for example, multiple polyps are the largest polyps. " There were 146 cases in male patients, 23.2% of the total, 482 in women, 76.8% in the total, and the age range of 1:3.13. patients was 21 to 86 years old. The average age of this group was 59.24 years.2. endoscopy in our hospital. The normal observation of all parts of the esophagus and stomach of the subjects, the general situation of polyps, including the location of the polyps, the maximum diameter of polyps, the bulge or flattening, the number and the surface of the mucous membrane, were examined by.3. histopathological examination for the direct electrocoagulation of the gastric polyps with a single diameter of less than or equal to 3mm, and the selection of polyps greater than 3mm A small portion of the biopsy was taken while the corresponding measures were removed. The multiple gastric polyps were taken from 1-2 tissues for biopsy. All the above tissues were collected by the pathological diagnosis of.4. in our hospital. The data were analyzed by SPSS 21 software. The measurement data were expressed in X + S or median, and the different types of data were used in x2 The test was compared, and P0.05 was statistically significant. Results 1. of the 628 patients were included in the study. The age was 21 years old, the maximum age was 86 years, and the average age was 59.24 years old. Among them, the age of the patients and the male patients were different, the 60 years old were more frequent, and the males were more than 60 years old, and there were statistically significant differences (X2=9.585, P=0.048). Men accounted for 23.2% (146/628), women accounted for 76.8% (482/628), the ratio of men and women was about 1:3.301, and women accounted for the majority. The incidence of female patients was compared with the incidence of male patients. The number of female patients was significantly higher than that of men. The difference was significant (X2=628, P0.001).2. clinical symptoms were mainly anti acid (18.1%), heartburn (15.9%), and pharynx (or pharynx). (3.7%), 3.7%), thinness, anorexia (2%), nausea and vomiting (5.2%), abdominal pain (20.9%), abdominal discomfort (5.6%), 333 cases (53%), multiple polyps in 295 (47%). The most common polyps of the stomach (49%) were hyperplastic polyps (35.7%), inflammatory polyps (9.1%), adenomatous polyps (2.1%) and inflammatory polyps (5.6%). 1.3%) < < 0.5cm gastric polyps most see, accounting for 70.9%.4. mountain field type I type I type I have 133 cases, accounting for 21%; type II type 472 cases, 75.2%; type III type 21 cases, 3.3%; type I, 2 cases, 0.3%, type I and type II polyps accounted for most. The stomach fundus and stomach body is the best location of gastric polyps, 28.8%, 36.6%. conclusion: gastric polyps women often hair; middle old and old people are more hair. Gastric polyps are the most common location of polyps, followed by gastric fundus, antrum, cardia, gastric angle and pylorus. Polyps in 0.5cm are the most common and less than 2.0cm polyps are rare; the most common in the Yamada type are type II; the most common gastric fundus polyps, second are proliferative polyps, and the others are inflammatory polyps, adenomatous polyps, and inflammatory polyps. Most of the gastric fundus polyps occur in the fundus of the stomach and the body of the stomach. Most of the hyperplastic polyps occur in the gastric and gastric antrum, and inflammatory polyps occur frequently in the cardia and antrum, and inflammatory polyps mainly occur in the gastric antrum.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573
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本文编号：1842711