CAJ | 학술논문

目的：分析镜下活检诊断为胃上皮内瘤变（GIN）的胃黏膜存在或者进展为高级别上皮内瘤变（HGIN）或胃癌的风险因素。方法收集胃镜活检诊断为GIN的349个病灶，按瘤变等级分为低级别上皮内瘤变组（LGIN组）和高级别上皮内瘤变组（HGIN组），分析两组病变的年龄、部位分布；另外将LGIN组中经内镜切除的41个病灶，根据切除标本的病理结果分别分为LGINL组与LGINH组；HGIN组中32个病灶全部行内镜或手术切除，按病理结果分为HGIN0组和Ca组，结合内镜表现和切除后病理结果，进行潜在恶变风险因素的分析。结果LGIN组和HGIN组发病年龄、病灶部位差异无统计学意义；LHINL组充血、溃疡性病变明显少于LGINH组，HGIN0组溃疡性病变明显少于Ca组（P＜0．05）；LGINL组病灶直径为（13．4±0．56）mm，LGINH组（22．6±0．53）mm（P＜0．05），＞20mm的病灶中80％为HGIN；HGIN0组直径（26．6±0．49）mm，Ca组（29．8±0．57）mm（P＜0．05），＞30mm的病灶中86．67％为胃癌。结论病灶充血、表面有溃疡是GIN可能存在或进展为HGIN或胃癌的风险；病灶直径＞20mm是LGIN可能存在或进展为HGIN的风险；病灶直径＞30mm是HGIN可能存在或进展为胃癌的风险。
목적：분석경하활검진단위위상피내류변（GIN）적위점막존재혹자진전위고급별상피내류변（HGIN）혹위암적풍험인소。방법수집위경활검진단위GIN적349개병조，안류변등급분위저급별상피내류변조（LGIN조）화고급별상피내류변조（HGIN조），분석량조병변적년령、부위분포；령외장LGIN조중경내경절제적41개병조，근거절제표본적병리결과분별분위LGINL조여LGINH조；HGIN조중32개병조전부행내경혹수술절제，안병리결과분위HGIN0조화Ca조，결합내경표현화절제후병리결과，진행잠재악변풍험인소적분석。결과LGIN조화HGIN조발병년령、병조부위차이무통계학의의；LHINL조충혈、궤양성병변명현소우LGINH조，HGIN0조궤양성병변명현소우Ca조（P＜0．05）；LGINL조병조직경위（13．4±0．56）mm，LGINH조（22．6±0．53）mm（P＜0．05），＞20mm적병조중80％위HGIN；HGIN0조직경（26．6±0．49）mm，Ca조（29．8±0．57）mm（P＜0．05），＞30mm적병조중86．67％위위암。결론병조충혈、표면유궤양시GIN가능존재혹진전위HGIN혹위암적풍험；병조직경＞20mm시LGIN가능존재혹진전위HGIN적풍험；병조직경＞30mm시HGIN가능존재혹진전위위암적풍험。
Objective To evaluate the potential predictive factors for high-grade intraepithelial neoplasia (HGIN) or risk factors for gastric cancer of gastric intraepithelial neoplasia (GIN) on the basis of endoscopic features .Methods This study involved 349 GIN that were histologically confirmed by endoscopic forceps biopsy (EFB).According to neoplasia grades,they were divided into low-grade intraepi-thelial neoplasia group(LGIN group) and the high-grade intraepithelial neoplasia group (HGIN group).Two groups of lesions,age and posi-tion distribution were review ed and analyzed .In addition,according to EMR/ESD postoperative pathological findings ,41 lesions which were involved in LGIN group were divided into LGINL group and LGINH group .According to the surgical operation postoperative pathological find-ings,all 32 lesions of HGIN group were divided into HGIN0 group and Ca group,then compared their endoscopic characteristics .Results There were no significant differences between LGIN group and HGIN group on the age and site .Congestion,ulcerative lesions LGINL group was obviously less than LGINH group,Ulcerative lesions HGIN0 group was obviously less than Ca group (P<0.05).The diameter of LGINL group was (13.4 ±0.56)mm,LGINH group(22.6 ±0.53)mm(P<0.05),the lesions which one >20mm in 80%of HGIN.The diameter of HGIN0 group was (26.6 ±0.49)mm,Ca group(29.8 ±0.57)mm(P<0.05),the lesions which one >30mm in 86.67%of gastric cancer. Conclusion Lesions congestion,the surface ulcer may be a sign of LGIN or the risk factor for gastric HGIN .Lesion diameter of more than 20mm is regarded as the sign of LGIN,or the risk of HGIN.Lesion diameter of more than 30mm is a sign of the presence HGIN or the risk factor for stomach neoplasms.