北京大学学报(医学版) ›› 2021, Vol. 53 ›› Issue (6): 1122-1127. doi: 10.19723/j.issn.1671-167X.2021.06.019
NIU Zhan-yue,XUE Yan,ZHANG Jing,ZHANG He-jun,DING Shi-gang()
摘要:
目的:分析胃腺瘤性息肉的内镜和病理特点,探讨其癌变的危险因素。方法:回顾性总结北京大学第三医院2005年1月1日至2019年12月31日的胃腺瘤性息肉患者的内镜和病理特点,并分析癌变的危险因素。结果:共纳入胃腺瘤性息肉患者125例,女性占51.20%,平均年龄为(66.7±12.3)岁,≥65岁的患者占64.80%,<45岁者仅占5.60%。腺瘤性息肉多分布在胃体和胃窦,分别占40.80%和32.80%,以单发(90.40%)、无蒂(76.81%)为主。65.94%的腺瘤性息肉直径≤1.0 cm。23.20%(29/125)的患者合并增生性息肉和/或胃底腺息肉,其中,合并多发息肉者占58.62%(17/29),1.60%(2/125)的患者同时存在两种病理类型的息肉,1.60%(2/125)的患者伴发G1期的胃神经内分泌肿瘤。13.60%(17/125)的腺瘤性息肉患者伴发胃癌,以进展期(70.59%)、未分化型(66.67%)癌为主。伴发低级别上皮内瘤变者为18.40%(23/125)。52.80%的背景胃黏膜是慢性萎缩性胃炎伴肠化生,自身免疫性胃炎占11.20%。幽门螺杆菌的阳性率为21.60%。胃腺瘤性息肉的癌变率为20.80%(26/125),癌变以分化型为主,但有的癌变为印戒细胞癌。直径>1.0 cm(OR=5.092,95%CI: 1.447~17.923,P=0.011)、表面形态不平伴有糜烂(OR=13.749,95%CI: 1.072~176.339,P=0.044)是癌变的独立危险因素。结论:胃腺瘤性息肉伴发胃癌的比例高、癌变率高,直径和表面形态是癌变的独立危险因素。内镜检查时应重视内镜下息肉病理类型的鉴别,并重视全胃黏膜的评估。
中图分类号:
[1] |
Carmack SW, Genta RM, Schuler CM, et al. The current spectrum of gastric polyps: A 1-year national study of over 120,000 patients[J]. Am J Gastroenterol, 2009, 104(6):1524-1532.
doi: 10.1038/ajg.2009.139 |
[2] |
Corral JE, Keihanian T, Diaz LI, et al. Management patterns of gastric polyps in the United States[J]. Frontline Gastroenterol, 2019, 10(1):16-23.
doi: 10.1136/flgastro-2017-100941 |
[3] |
Enestvedt BK, Chandrasekhara V, Ginsberg GG. Endoscopic ultrasonographic assessment of gastric polyps and endoscopic mucosal resection[J]. Curr Gastroenterol Rep, 2012, 14(6):497-503.
doi: 10.1007/s11894-012-0292-2 pmid: 23001857 |
[4] |
Velázquez-Dohorn ME, López-Durand CF, Gamboa-Domínguez A. Changing trends in gastric polyps[J]. Rev Invest Clin, 2018, 70(1):40-45.
doi: 10.24875/RIC.17002430 pmid: 29513301 |
[5] |
Castro R, Pimentel-Nunes P, Dinis-Ribeiro M. Evaluation and management of gastric epithelial polyps[J]. Best Pract Res Clin Gastroenterol, 2017, 31(4):381-387.
doi: S1521-6918(17)30060-4 pmid: 28842047 |
[6] |
Chen WC, Wallace MB. Endoscopic management of mucosal lesions in the gastrointestinal tract[J]. Expert Rev Gastroenterol Hepatol, 2016, 10(4):481-495.
doi: 10.1586/17474124.2016.1122520 |
[7] | Banks M, Graham D, Jansen M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma[J]. Gut, 2019, 68(9):1545-1575. |
[8] |
Laxén F, Sipponen P, Iham?ki T. Gastric polyps: their morphological and endoscopical characteristics and relation to gastric carcinoma[J]. Acta Pathol Microbiol Immunol Scand A, 1982, 90(3):221-228.
pmid: 7102316 |
[9] |
Borch K, Skarsgard J, Franzen L, et al. Benign gastric polyps: Morphological and functional origin[J]. Dig Dis Sci, 2003, 48(7):1292-1297.
doi: 10.1023/A:1024150924457 |
[10] |
Zhao G, Xue M, Hu Y, et al. How commonly is the diagnosis of gastric low grade dysplasia upgraded following endoscopic resection? A meta-analysis[J]. PLoS One, 2015, 10(7):e0132699.
doi: 10.1371/journal.pone.0132699 |
[11] |
de Vries AC, van Grieken NC, Looman CW, et al. Gastric cancer risk in patients with premalignant gastric lesions: A nationwide cohort study in the Netherlands[J]. Gastroenterology, 2008, 134(4):945-952.
doi: 10.1053/j.gastro.2008.01.071 |
[12] |
Meining A, Riedl B, Stolte M. Features of gastritis predisposing to gastric adenoma and early gastric cancer[J]. J Clin Pathol, 2002, 55(10):770-773.
pmid: 12354805 |
[13] |
Zhang H, Jin Z, Cui R, et al. Autoimmune metaplastic atrophic gastritis in chinese: A study of 320 patients at a large tertiary medical center[J]. Scand J Gastroenterol, 2017, 52(2):150-156.
doi: 10.1080/00365521.2016.1236397 |
[14] |
Zhang H, Nie X, Song Z, et al. Hyperplastic polyps arising in autoimmune metaplastic atrophic gastritis patients: Is this a distinct clinicopathological entity[J]. Scand J Gastroenterol, 2018, 53(10/11):1186-1193.
doi: 10.1080/00365521.2018.1514420 |
[15] |
Suzuki S, Gotoda T, Suzuki H, et al. Morphologic and histologic changes in gastric adenomas after Helicobacter pylori eradication: A long-term prospective analysis[J]. Helicobacter, 2015, 20(6):431-437.
doi: 10.1111/hel.12218 pmid: 25704290 |
[16] |
Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection: the Maastricht V/Florence Consensus Report[J]. Gut, 2017, 66(1):6-30.
doi: 10.1136/gutjnl-2016-312288 pmid: 27707777 |
[17] |
Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endosco-pic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline[J]. Endoscopy, 2015, 47(9):829-854.
doi: 10.1055/s-0034-1392882 pmid: 26317585 |
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