胃腺瘤性息肉临床特征分析  

Clinical features of gastric adenomatous polyps

作　　者：黄尔炯[1] 董乐妹[1] 金尹[1] 洪万东[1] 陶利萍[1] 沈贤[2] 吴建胜[1] 

机构地区：[1]温州医科大学附属第一医院消化内科,浙江温州325000 [2]温州医科大学附属第一医院胃肠外科,浙江温州325000

出　　处：《中国实用内科杂志》2016年第3期238-241,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(31470891);温州市科技计划项目(Y20140081)

摘　　要：目的探讨胃腺瘤性息肉的临床特征。方法收集2007年1月至2015年5月温州医科大学附属第一医院所有胃腺瘤性息肉患者的临床资料并进行总结分析。结果胃镜检查发现胃腺瘤性息肉患者78例,占同期全部胃镜检查患者数的0.026%,以中老年多见。临床常以上腹不适（31/78,39.7%）、上腹痛（8/78,10.3%）、胃食管反流症状（4/78,5.1%）等非特异性表现行胃镜检查而发现。胃镜下,胃腺瘤性息肉多位于胃体（19/78,24.4%）或胃窦（39/78,50.0%）,呈现单发（59/78,75.6%）或2~5枚（15/78,19.2%）,≤20 mm（71/78,91.0%）的广基黏膜隆起,息肉形态大部分呈山田Ⅰ型（44/78,56.4%）、Ⅱ型（29/78,37.2%）。病理表现为密集排列拥挤的增生旺盛的腺体,常伴有周围黏膜形态学和组织学异常,其中伴萎缩性胃炎9例（9/78,11.5%）,肠上皮化生7例（7/78,9.0%）,胃腺癌1例（1/78,1.3%）。15例胃腺瘤性息肉患者同时完成了结肠镜检查,结直肠肿瘤检出率高达66.7%（10/15）。同期行胃肠镜检查而胃镜示无胃腺瘤性息肉并且性别年龄匹配的对照组中结直肠肿瘤检出率为17.8%（8/45）。两组间差异有统计学意义（χ2=9.626,P=0.002）。17例患者术后定期随访,其中3例患者复查时胃镜及病理提示腺瘤性息肉复发。结论胃腺瘤性息肉临床症状缺乏特异性,有癌变的风险,可以合并胃内其他病变,在正确处理胃息肉的同时,应重视周围胃黏膜的变化,且应重视术后随访及结直肠肿瘤的筛查。Objectives To investigate the clinical characteristics of gastric adenomatous polyps. Methods Data of patients with gastric adenomatous polyps diagnosed from January 2007 to May 2015 were collected and retrospectively analyzed. Results A total of 78 patients were found to have gastric adenomatous polyps, accounting for 0.026% of total upper endoscopy examinations at the same time period. It was most frequently seen in the middle-aged and elderly patients. Clinical symptoms was nonspecific, including abdominal discomfort（31/78, 39.7%）, gastroesophageal reflux symptoms（4/78, 5.1%）and upper abdominal pain（8/78, 10.3%）. About 24.4%（19/78） of the polyps were located in the corpus and 50.0%（39/78） were at antrum, with most of gastric adenomatous polyps were single polyp（59/78, 75.6%）with broad base which was often less than 20 mm in diameter（71/78, 91.0%）.The polyps mainly were Yamada type Ⅰ（44/78, 56.4%）or type Ⅱ（29/78, 37.2%）.The pathology typically showed gastric adenomas consisting of dysplastic epithelial cells that often arised in a background of atrophy（9/78, 11.5%）and intestinal metaplasia（7/78, 9.0%）typically. And 1 case was found accompanied with gastric cancer. Fourteen gastric adenomatous polyps patients underwent colonoscopy during the same period. Colorectal neoplasia were identified in 10（66.7%） of 15 cases and in 8（17.8%） of 45 controls（χ2=9.626, P =0.002）. Adenomatous polyps recurrence had been found in 3 patients after complete endoscopic excision or surgery during follow-up. Conclusion The symptoms of gastric adenomatous polyps are often nonspecific. Adenomatous polyps have malignant potential, and there is also a strong association between gastric adenoma and synchronous gastric mucosal abnormalities. So they should be endoscopically removed when possible. Patients with adenomatous polyps are at a significantly higher risk for colorectal neoplasia.Endoscopic follow-up is required following resection of gastric adenomas. A screening colonos

关 键 词：腺瘤 腺瘤性息肉 胃镜 

分 类 号：R573.9[医药卫生—消化系统]