胃黏膜萎缩、肠上皮化生及异型增生的放大内镜表现及其诊断价值  

Magnifying endoscopic manifestation of gastric atrophy, intestinal metaplasia or dysplasia and its diagnostic value

作　　者：黄永辉[1] 周丽雅[1] 林三仁[1] 金珠[1] 刘建军[1] 丁士刚[1] 夏志伟[1] 段丽萍[1] 常红[1] 

机构地区：[1]北京大学第三医院消化科,100083

出　　处：《中华消化内镜杂志》2005年第4期231-235,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的确定胃黏膜萎缩、肠上皮化生及异型增生的形态学特征,探讨放大内镜结合染色对上述病变诊断的可行性和准确性。方法应用Fujinon EG485 ZH型放大内镜对100例患者进行检查及0.5%美蓝染色,在确定A、B、C、D、E 5型基本胃小凹形态的基础上,制订放大内镜的诊断分型及放大内镜对萎缩、肠上皮化生和异型增生的判定标准,与相应部位活检所获得的417个病变组织的病理组织学检查结果进行比较分析。结果胃黏膜萎缩主要表现为胃小凹粗大而分布稀疏,肠上皮化生表现为C、D、E型小凹形态伴美蓝着色阳性,异型增生表现为轻度凹陷、隆起或平坦性病变伴细微结构消失、细微小凹或细微结构粗糙紊乱。放大内镜对萎缩诊断的敏感性、特异性分别为95.85% 和95.09%;对肠上皮化生分别为88.30%和90.83%;对异型增生分别为91.52%和94.41%,均明显高于普通内镜。结论根据放大内镜下萎缩、肠上皮化生和异型增生的形态学特征可以使内镜对上述病变诊断的准确性明显提高。To study on the results of magnifying endoscopy in gastric atrophy, intestinal metaptasia （ IM ） and dysplasia, and evaluate their feasibility and accuracy for the diagnosis of these lesions. Methods One hundred patients were examined by magnifying endoscopy, Fujinon EG485 ZH modal, and stained with 0. 5% methylene blue. After defining magnifying endoscopic patterns of gastric pits as types A, B, C, D, and E, the diagnostic classification and endoscopic criteria were developed for the diagnosis of atrophy, IM and dysplasia. The results of 417 histnpathological biopsy specimens taken from the corresponding areas of gastric mucnsa under magnifying endoscopy were regarded as gold standard. Results Sparse and thick gastric pits nainly appeared in gastric atrophy. IM mainly appeared in gastric mucosa of type C, type D, and type E with positive stain, dysplasia appeared as depressed, slightly raised, or flat mucosa accompanied by loss of clear pattern, fine pits or coarse and irregular microstructure. The sensitivity and specificity of magnifying endoscopies in the diagnosis of atrophy, IM and dysphasia were 95.85% , 95.09% , 88.30% ,90. 83% , and 91.52% , 94.41% respectively, all were higher than those of routine endoscopy. Conclusion The diagnostic accuracy significantly increased as depending upon the morphological features of gastric atrophy, IM, or dysplasia trader magnifying endoscopy.

关 键 词：胃黏膜萎缩 肠上皮化生 肠上皮异型增生 放大内镜 诊断价值 内镜表现 

分 类 号：R57[医药卫生—消化系统]