胃黏膜不典型增生患者的内镜随访和治疗价值分析  

Values of Endoscopic Follow-up and Therapy for Gastric Epithelial Dysplasia

作　　者：张黎明[1] 刘华[2] 刘莉莉[3] 刘希双[2] 

机构地区：[1]山东省枣庄市立医院消化科,277102 [2]青岛大学医学院附属医院内镜中心 [3]山东省枣庄市立医院妇产科,277102

出　　处：《中国全科医学》2013年第26期3126-3128,共3页Chinese General Practice

摘　　要：目的探讨内镜随访对胃黏膜不典型增生患者的临床意义及内镜下黏膜切除术治疗不典型增生的效果。方法对我院2000—2008年经内镜和病理诊断为胃黏膜不典型增生的180例患者(随访组)和因重度不典型增生行内镜下黏膜切除术治疗的80例患者(治疗组)进行1～7年的连续内镜随访,对比分析两组患者疾病逆转和发生癌变的情况。结果随访组随访发现,轻度不典型增生患者的逆转率为75.7%,癌变率为2.9%;中度不典型增生患者的逆转率为64.5%,癌变率为6.5%;重度不典型增生患者的逆转率为31.3%,癌变率为27.1%;随访组不同程度不典型增生患者的逆转率和癌变率间差异有统计学意义(χ2=24.261、19.388,P<0.05)。治疗组随访发现癌变率为1.25%(1/80),与随访组癌变率10.6%(19/180)比较,差异有统计学意义(χ2=6.754,P<0.05)。结论对胃黏膜不典型增生患者进行连续内镜随访是发现早期胃癌的有效途径,内镜下黏膜切除术是治疗胃黏膜不典型增生的有效方法,可减少癌变率。Objective To investigate the clinical significance of endoscopic follow -ups to gastric epithelial dysplasia （GED） patients and the therapeutic effects of endoscopic mucosal resection. Methods A 1 - 7 - year consecutive endoscopic follow- up was carried out in 180 GED patients diagnosed by endoscopy, pathology （follow- up group） and 80 receiving endo- scopic mucosal resection （therapy group） in this hospital from 2000 to 2008. Disease reverse and cancerous changes were ob- served in two groups. Results In follow - up group, rates of reverse and cancerous changes were 75.7 %, 2. 9% , respective- ly, in mild GED patients; 64. 5% , 6. 5% , respectively, in moderate patients; 31.3% , 27. 1%, respectively, in severe pa- tients; there was significant difference between patients with different degrees of GED （x^2 =24. 261, 19. 388; P 〈0. 05）. The cancerous change rate of therapy group was 1.25% （1/80） , different from that of follow- up group （x^2 =6. 754, P 〈0.05 ）. Conclusion Consecutive endoscopic follow - ups to GED patients is an effective way to find out early gastric cancers. Endoscop- ic mucosal resection, a useful method for GED, can reduce rate of cancerous changes.

关 键 词：内窥镜检查 胃肠道 胃黏膜 胃肿瘤 随访研究 不典型增生 内镜下黏膜切除术 

分 类 号：R435.2[医药卫生—临床医学]