胃腺瘤性息肉内镜病理特点及癌变特征分析  

Analysis of endoscopic pathological characteristics and canceration characteristics of gastric adenomatous polyps

作　　者：蒋琦[1,2] 刘卫东 惠文佳[1,2] 高峰 JIANG Qi;LIU Wei-dong;HUI Wen-jia;GAO Feng(Department of Gastroenterology,People′s Hospital of Xinjiang Uygur Autonomous Region;Xinjiang Clinical Research Center for Digestive Diseases,Urumqi 830001,Xinjiang,China)

机构地区：[1]新疆维吾尔自治区人民医院消化内科,830001 [2]新疆消化系统疾病临床医学研究中心,830001

出　　处：《现代消化及介入诊疗》2023年第2期173-176,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：新疆维吾尔自治区科技支疆计划项目(2022E02041)。

摘　　要：目的探讨新疆地区胃腺瘤性息肉临床、内镜、病理特征及癌变的高危因素。方法回顾性分析新疆维吾尔自治区人民医院2012年1月至2022年10月间胃腺瘤性息肉患者的临床、内镜及病理资料。结果共纳入胃腺瘤性息肉患者111例,男性53例(47.75%),女性58例(52.25%);年龄37~79岁(61.0±9.5)岁。腺瘤性息肉以汉族和维吾尔族患者居多,分别占65.77%和20.72%。幽门螺旋杆菌阳性率为67.21%(41/60)。息肉多分布于胃体、胃底(41.44%)和胃窦(48.65%),以山田Ⅰ型(73.87%)为主。病理类型以管状腺瘤(47.75%)为主,伴肠型化生(52.25%)、低级别上皮内瘤变(36.94%)。47.75%(53/111例)的患者合并其他疾病。6.31%的患者伴同时性胃腺癌。45.95%的患者胃黏膜背景为慢性萎缩性胃炎伴肠化。胃型腺瘤性息肉≥65岁患者明显多于肠型,且仅分布于胃体胃底,以多发为主,黏膜背景以慢性非萎缩性胃炎常见(P<0.05)。息肉数目(OR=4.551,95%CI:1.322~15.66,P=0.016)及黏膜背景(OR=4.852,95%CI:1.167~20.171,P=0.016)是高风险腺瘤性息肉的独立危险因素。结论腺瘤性息肉以汉族、山田Ⅰ型及肠型为主,癌变率较高;多发息肉、黏膜背景为慢性非萎缩性胃炎是腺瘤性息肉癌变的独立危险因素。Objective To investigate the clinical,endoscopic,pathological features,and high-risk factors for cancerous transformation of gastric adenomatous polyps in Xinjiang Autonomous Region.Methods The clinical,endoscopic and pathological data of patients with gastric adenomatous polyps from January 2012 to October 2022 in the People′s Hospital of Xinjiang Uygur Autonomous Region were analyzed retrospectively.Results A total of 111 patients with gastric adenomatous polyps were included,including 53 males(47.75%)and 58 females(52.25%);Age range from 37 to 79 years old(61.0±9.5).Adenomatous polyps are mostly seen in Han and Uyghur patients,accounting for 65.77%and 20.72%respectively.The positive rate of Helicobacter pylori was 67.21%(41/60).Polyps are mostly distributed in the gastric body,fundus(41.44%),and antrum(48.65%),with Yamada type I(73.87%)being the main type.The pathological type is mainly tubular adenoma(47.75%),accompanied by intestinal metaplasia(52.25%),and low-grade intraepithelial neoplasia(36.94%).47.75%(53/111 cases)of patients had other diseases.6.31%of patients have concurrent gastric adenocarcinoma.The background of gastric mucosa of 45.95%patients was chronic atrophic gastritis with intestinal metaplasia.Gastric type adenomatous polyp≥65 years old are significantly more common in patients than intestinal type,and are only distributed in the gastric body and fundus,with multiple lesions.Chronic non atrophic gastritis is a common mucosal background(P<0.05).The number of polyps(OR=4.551,95%CI:1.322-15.66,P=0.016)and mucosal background(OR=4.852,95%CI:1.167-20.171,P=0.016)are independent risk factors for high-risk adenomatous polyps.Conclusion Adenomatous polyps are predominantly of Han Chinese,Yamada type I and intestinal type,and have a high rate of carcinogenesis;Multiple polyps,mucosal background chronic non atrophic gastritis is an independent risk factor for the carcinogenesis of adenomatous polyps.

关 键 词：胃型腺瘤性息肉 肠型腺瘤性息肉 内镜检查 危险因素 

分 类 号：R573[医药卫生—消化系统]