胃黏膜低级别上皮内瘤变的胃复春联用叶酸治疗及转归研究  

Gastric mucosal low-grade intraepithelial neoplasia treated with Weifuchun combined with folic acid and its outcome

作　　者：杨湘怡[1] 吴云林[2] 朱燕华[2] 唐志鹏[3] 朱生粱[4] 冯莉[5] 徐萍[6] 李爽[6] 王虹[7] 熊文坚[1] 

机构地区：[1]上海市徐汇区中心医院消化科,上海200031 [2]上海交通大学医学院附属瑞金医院消化内科,上海200025 [3]上海中医药大学附属龙华医院消化科,上海200032 [4]上海中医药大学附属岳阳医院消化科,上海200437 [5]上海瑞金医院集团闵行区中心医院消化科,上海201100 [6]上海市松江区中心医院消化科,上海201600 [7]上海市静安区中心医院消化科,上海200031

出　　处：《内科理论与实践》2013年第1期24-28,共5页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:探讨胃复春联用叶酸治疗胃黏膜低级别上皮内瘤变及临床转归。方法:收集上海市7所不同等级医院2011年1月至2011年12月经胃镜活组织检查(活检)病理证实的胃黏膜低级别上皮内瘤变患者共198例,应用胃复春联用叶酸的方案进行药物治疗,并进行定期随访及内镜复查,符合指征者行内镜或外科手术治疗及病理学检查,了解其疗效、转归及胃癌漏诊情况。结果:胃黏膜上皮内瘤变病灶主要位于胃窦(66.7%),镜下表现多样,主要为粗糙糜烂(37.9%)。药物治疗后患者临床症状总改善率为76.3%。最终随访结果显示,胃黏膜上皮内瘤变病灶完全消退47例(23.7%),病理消退72例(36.4%),不变55例(27.8%),进展22例(11.1%)及腺瘤样变2例(1.0%),总消退率为60.1%。进展患者中符合漏诊者达50.0%。结论:胃复春联用叶酸能有效缓解胃黏膜上皮内瘤变患者的临床症状,部分消退低级别上皮内瘤变。对低级别上皮内瘤变患者进行定期胃镜随访有望早期检出胃癌病灶,部分胃黏膜上皮内瘤变同时存有癌变病灶,内镜短期、重复检查可减少胃癌漏诊率。Objective To study the therapeutic response of gastric mucosal low grade intraepithelial neoplasia treated with Weifuchun combined with folic acid. Methods One hundred and ninety eight cases of gastric mucosal low grade intraepithelial neoplasia confirmed by biopsy from seven hospitals in Shanghai were enrolled. Patients were treated with Weifuchun combined with folic acid, and were followed regularly with gastroscopic examination as needed. The therapeutic response and outcome were analyzed. Results Gastric low grade intraepithelial neoplasia lesions were located mainly in the antrum （66.7%）; endoscopic manifestation mainly were rough erosion （37.9%）. The overall symptomatic improvement rate was 76.3%. Final follow-up results showed that 47 cases （23.7%） had their lesions completely resolved , 72 cases （36.4%） had their lesions receded, 55 cases （27.8%） unchanged, 22 cases （11.1%） progressed and adenoma-like changes occurred in 2 cases （1.0%）. The overall regression rate was 60.1%. Of the cases with progression, 50.0% fulfilled the criteria of missing diagnosis. Conclusions Weifuchun combined with folic acid could effectively alleviate thesymptoms of gastric mucosal intraepithelial neoplasia, and partially regressed the low-grade neoplasia. Regular gastroscopic follow up could help the early detection of cancerous lesion. Some of the gastric mucosal intraepithelial neoplasia lesions had coexisted cancerous lesion. Frequent and regular gastroscopic follow up could decrease the missing diagnosis of cancerous lesion.

关 键 词：低级别胃黏膜上皮内瘤变 治疗 随访 

分 类 号：R735.2[医药卫生—肿瘤]