胃腺瘤性息肉临床特征分析
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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 colonoscopy may be necessary for patients with adenomatous polyps to detect colorectal neoplasia.
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 colonoscopy may be necessary for patients with adenomatous polyps to detect colorectal neoplasia.
引文
[1]刘彤华.诊断病理学[M].北京:人民卫生出版社,2013:51.
[2]林泳,聂玉强,王红,等.近15年2643例胃息肉临床病理学特征和变化趋势分析[J].中华消化杂志,2014,34(4):247-250.
[3]纪小龙.消化道病理学[M].北京:人民军医出版社,2010:194-195.
[4]ASGE Standards of Practice Committee,Evans JA,Chandrasekhara V,et al.The role of endoscopy in the management of premalignant and malignant conditions of the stomach[J].Gastrointest Endosc,2015,82(1):1-8.
[5]于皆平,黄杰安.胃肠道息肉及息肉病诊治的有关进展[J].中国实用内科杂志,2000,20(2):67-70.
[6]吴浩,邹文斌,刘枫,等.早期胃癌及癌前病变内镜下切除治疗现状及进展[J].中国实用内科杂志,2014,34(5):530-538.
[7]Kim SY,Sung JK,Moon HS,et al.Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia?[J].Gut Liver,2012,6(4):446-451.
[8]Yang MH,Son HJ,Lee JH,et al.Do we need colonoscopy in patients with gastric adenomas?The risk of colorectal adenoma in patients with gastric adenomas[J].Gastrointest Endosc,2010,71(4):774-781.
[9]朐蕊,曹海龙,王邦茂,等.上消化道腺瘤与结直肠肿瘤相关性的病例对照研究[J].中华消化内镜杂志,2012,29(9):500-502.
[10]赵子夜,李骏强,单永琪,等.结直肠癌平均风险人群结肠镜检查的息肉与腺瘤检出率及其年龄分布情况[J].中华消化内镜杂志,2014,31(2):64-68.
[11]Abraham SC,Park SJ,Lee JH,et al.Genetic alterations in gastric adenomas of intestinal and foveolar phenotypes[J].Mod Pathol,2003,16(8):786-795.
[2]林泳,聂玉强,王红,等.近15年2643例胃息肉临床病理学特征和变化趋势分析[J].中华消化杂志,2014,34(4):247-250.
[3]纪小龙.消化道病理学[M].北京:人民军医出版社,2010:194-195.
[4]ASGE Standards of Practice Committee,Evans JA,Chandrasekhara V,et al.The role of endoscopy in the management of premalignant and malignant conditions of the stomach[J].Gastrointest Endosc,2015,82(1):1-8.
[5]于皆平,黄杰安.胃肠道息肉及息肉病诊治的有关进展[J].中国实用内科杂志,2000,20(2):67-70.
[6]吴浩,邹文斌,刘枫,等.早期胃癌及癌前病变内镜下切除治疗现状及进展[J].中国实用内科杂志,2014,34(5):530-538.
[7]Kim SY,Sung JK,Moon HS,et al.Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia?[J].Gut Liver,2012,6(4):446-451.
[8]Yang MH,Son HJ,Lee JH,et al.Do we need colonoscopy in patients with gastric adenomas?The risk of colorectal adenoma in patients with gastric adenomas[J].Gastrointest Endosc,2010,71(4):774-781.
[9]朐蕊,曹海龙,王邦茂,等.上消化道腺瘤与结直肠肿瘤相关性的病例对照研究[J].中华消化内镜杂志,2012,29(9):500-502.
[10]赵子夜,李骏强,单永琪,等.结直肠癌平均风险人群结肠镜检查的息肉与腺瘤检出率及其年龄分布情况[J].中华消化内镜杂志,2014,31(2):64-68.
[11]Abraham SC,Park SJ,Lee JH,et al.Genetic alterations in gastric adenomas of intestinal and foveolar phenotypes[J].Mod Pathol,2003,16(8):786-795.