活检诊断为胃上皮内瘤变的临床特征及漏诊癌变的危险因素分析

发布时间：2019-05-22 14:52

【摘要】：目的:探讨胃黏膜病灶活检病理为上皮内瘤变的临床特征及漏诊癌变的相关危险因素分析,进而提高胃上皮内瘤变活检诊断的准确率。方法:回顾性收集2010年12月1日至2016年12月1日共203例术前活检诊断为胃黏膜上皮内瘤变住院患者的病例资料,分别统计性别、年龄、临床症状、病灶部位、病灶大小、病灶内镜下形态、病灶病理类型、治疗方法等指标。结果:203例GIN患者中,男女比例为2.63:1;60岁以上的患者占66.5%;病灶位于胃窦和胃角的共占70.9%;病灶大小在1.0cm以上的占78.3%;内镜下分型中隆起型占21.2%,表浅型占58.6%,凹陷型占20.2%;胃粘膜萎缩率为62.1%,肠化率为52.7%,HP阳性率为47.5%。根据活检病理结果分为LGIN组(111例)和HGIN组(92例),2组在性别(P=0.001)、病灶大小≥2.0cm(P=0.023)、内镜分型(P=0.001)、胃粘膜萎缩(P=0.008)、肠化(P=0.001)、HP感染(P=0.003)方面存在差异。203例患者中有149例行手术治疗,术后病理证实为LGIN者35例,HGIN者25例,EGC者75例,AGC者14例。根据术后病理结果分为GIN组(60例)和GC组(89例)。单因素分析提示组间存在差异的有性别(P=0.002)、吸烟(P=0.038)、饮酒(P=0.017)、病灶大小≥2.0cm(P=0.007)、溃疡凹陷型(P=0.000)、萎缩(P=0.002)、肠化(P=0.000)、HP感染(P=0.000)。多因素Logistic回归提示病灶大小≥ 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)、溃疡凹陷型(OR=8.899,95%CI:1.863-42.514,P=0.006)以及活检病理诊断为HGIN(OR=14.735,95%CI:4.830-44.952,P=0.000)是活检病理为GIN漏诊癌变的危险因素。结论:住院患者中,胃上皮内瘤变易发生于大于60岁的老年男性患者,病灶主要位于胃窦和胃角,病灶大小多在1.Ocm以上,内镜下分型以表浅型多见,胃粘膜多伴有萎缩;活检病理诊断为低级别上皮内瘤变和高级别上皮内瘤变在性别构成、病灶大小≥2.0cm、病灶内镜下分型、粘膜萎缩、肠化、HP感染方面存在差异;对于活检病理提示胃上皮内瘤变的胃黏膜病灶,如病理为高级别上皮内瘤变或病灶大小≥2.0 cm或内镜下形态呈溃疡凹陷型或有HP感染,需警惕活检漏诊癌变的可能。
[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，

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