胃炎性纤维性息肉49例的临床与内镜下特点分析  

Clinical and endoscopic features of 49 cases of gastric inflammatory fibroid polyp

作　　者：骆定海[1] 郑海红[2] 毛鑫礼[1] 何赛琴[3] 何必立[1] 徐铖[2] 叶丽萍[1] Luo Dinghai;Zheng Haihong;Mao Xinli;He Saiqin;He Bili;Xu Cheng;Ye Liping(Department of Gastroenterology,Taizhou Hospital of Zhejiang Province,Linhai City,Zhejiang Province 317000,China)

机构地区：[1]浙江省台州医院消化内科,浙江省临海市317000 [2]浙江省台州医院病理科,浙江省临海市317000 [3]浙江省台州医院内镜中心,浙江省临海市317000

出　　处：《中华消化杂志》2018年第10期664-668,共5页Chinese Journal of Digestion

摘　　要：目的总结胃炎性纤维性息肉（IFP）患者的胃镜下表现、超声内镜下表现和病理特点，提高诊断能力。方法纳入2011年9月至2016年11月在浙江省台州医院行内镜下治疗并经病理确诊的49例胃IFP患者，回顾性分析其病史、内镜检查、治疗和随访情况。结果49例胃IFP患者中，男16例，女33例，平均年龄为54岁；病灶最大径为1.0～2.0 cm者33例（67.3%）；病灶单发48例，多发1例；病变位于胃窦前壁17例（34.7%），胃窦后壁7例（14.3%），胃窦小弯侧7例（14.3%），胃窦大弯侧7例（14.3%）。41例患者行超声内镜检查，位于黏膜下层28例，位于黏膜层、黏膜肌层13例，超声内镜检查误诊率为29.3%（12/41）；表现为低回声结构26例，高回声结构11例，偏低回声结构4例。所有患者均在内镜下一次性切除成功，无一例出现并发症；其中行内镜黏膜下剥离术（ESD）37例，行内镜黏膜切除术（EMR）12例。所有患者术前均未能明确诊断，最后经病理确诊。术后病理检查显示，黏膜下层或黏膜固有层梭形细胞增生，束状、交错状排列，或以瘤细胞围绕小血管及黏膜腺体形成旋涡状或洋葱皮样结构。47例患者获得随访，中位随访时间为31个月，至截稿患者均存活，且无病灶复发及转移。结论胃IFP术前误诊率高，确诊有赖于组织病理学诊断。因大部分病灶最大径〈5 cm，首选内镜下切除治疗。ObjectiveTo summarize the endoscopic appearance, endoscopic ultrasound findings and histopathological characteristics of gastric inflammatory fibroid polyp （IFP） in order to improve diagnosis of IFP.MethodsFrom September 2011 to November 2016, 49 patients with pathologically comfirmed gastric IFP, who underwent endoscopy in Taizhou Hospital of Zhejiang Province, were enrolled. The medical history, endoscopic examination, treatment and follow-up were retrospectively analyzed.ResultsAmong 49 patients with gastric IFP （16 males and 33 females; average age 54 years） the maximum diameter of 33 cases （67.3%） was between 1.0 cm and 2.0 cm. Forty-eight cases had single lesion and one case had multiple lesions. The lesions of 17 cases （34.7%） were located at the anterior wall of gastric antrum, the lesions of seven cases （14.3%） were at the posterior wall of gastric antrum, the lesions of seven cases （14.3%） were at the lesser curvature of gastric antrum and the lesions of seven cases （14.3%） were at the great curvature of gastric antrum. Among the lesions of 41 patients who received endoscopic ultrasonography, 28 lesions were located in the submucosa of stomach, 13 lesions were located in mucosa and muscularis mucosa. The rate of misdiagnosis of endoscopic ultrasonography was 29.3%（12/41）. The endoscopic ultrasound findings of the lesions included 26 hypoechoic structures, 11 hyperechoic structures and four slightly hypoechoic structures. The lesions of all the patients were successfully removed by endoscopic polypectomy without any complication. Thirty-seven lesions were treated by endoscopic submucosal dissection （ESD） and 12 lesions by endoscopic mucosal resection （EMR）. All the patients were not clearly diagnosed before operation and were finally diagnosed by pathological examination. Postoperative pathological examination showed that in the suhmucosa and mucosa lamina propria, spindle-shaped cells proliferated and arranged in an interwoven pattern or cells around vessels or mu

关 键 词：胃肠疾病 诊断 胃炎性纤维性息肉 内镜表现 治疗 

分 类 号：R573[医药卫生—消化系统]