中华消化病与影像杂志(电子版)
中華消化病與影像雜誌(電子版)
중화소화병여영상잡지(전자판)
2015年
4期
8-12
,共5页
朱燕华%吴云林%吴巍%张梦茵%程时丹%郭滟%蔚青%胡伟国
硃燕華%吳雲林%吳巍%張夢茵%程時丹%郭滟%蔚青%鬍偉國
주연화%오운림%오외%장몽인%정시단%곽염%위청%호위국
胃肿瘤%诊断%治疗学
胃腫瘤%診斷%治療學
위종류%진단%치료학
Stomach neoplasms%Diagnosis%Therapeutics
目的:探讨胃黏膜低级别上皮内瘤变的诊断、治疗方法及随访方案。方法收集2009年1月至2012年12月上海交通大学医学院附属瑞金医院332例经胃镜活检病理证实的胃黏膜低级别上皮内瘤变患者的临床资料。所有患者均应用胃复春联用叶酸进行药物治疗,并进行定期随访及内镜复查,符合指征者行内镜或外科手术治疗及病理学检查,评估其临床疗效、病灶转归及胃癌漏诊情况。结果53.01%(176/332)胃黏膜低级别上皮内瘤变患者临床表现为上腹隐痛不适,83.13%(276/332)患者病灶多位于下1/3胃,内镜下形态各异。所有患者平均随访(14.67±30.99)个月后,经联合治疗临床症状总改善率为76.51%(254/332),病灶总消退率为62.95%(209/332)。共检出胃癌28例,其中符合胃癌漏诊或可能漏诊者10例(35.71%,10/28)。结论胃复春联用叶酸能有效缓解胃黏膜低级别上皮内瘤变患者的临床症状,部分消退低级别瘤变病灶。对胃黏膜低级别上皮内瘤变患者进行定期胃镜随访有望早期检出胃癌病灶。部分胃黏膜上皮内瘤变同时存有癌灶,内镜短期、重复检查可减少胃癌漏诊率。
目的:探討胃黏膜低級彆上皮內瘤變的診斷、治療方法及隨訪方案。方法收集2009年1月至2012年12月上海交通大學醫學院附屬瑞金醫院332例經胃鏡活檢病理證實的胃黏膜低級彆上皮內瘤變患者的臨床資料。所有患者均應用胃複春聯用葉痠進行藥物治療,併進行定期隨訪及內鏡複查,符閤指徵者行內鏡或外科手術治療及病理學檢查,評估其臨床療效、病竈轉歸及胃癌漏診情況。結果53.01%(176/332)胃黏膜低級彆上皮內瘤變患者臨床錶現為上腹隱痛不適,83.13%(276/332)患者病竈多位于下1/3胃,內鏡下形態各異。所有患者平均隨訪(14.67±30.99)箇月後,經聯閤治療臨床癥狀總改善率為76.51%(254/332),病竈總消退率為62.95%(209/332)。共檢齣胃癌28例,其中符閤胃癌漏診或可能漏診者10例(35.71%,10/28)。結論胃複春聯用葉痠能有效緩解胃黏膜低級彆上皮內瘤變患者的臨床癥狀,部分消退低級彆瘤變病竈。對胃黏膜低級彆上皮內瘤變患者進行定期胃鏡隨訪有望早期檢齣胃癌病竈。部分胃黏膜上皮內瘤變同時存有癌竈,內鏡短期、重複檢查可減少胃癌漏診率。
목적:탐토위점막저급별상피내류변적진단、치료방법급수방방안。방법수집2009년1월지2012년12월상해교통대학의학원부속서금의원332례경위경활검병리증실적위점막저급별상피내류변환자적림상자료。소유환자균응용위복춘련용협산진행약물치료,병진행정기수방급내경복사,부합지정자행내경혹외과수술치료급병이학검사,평고기림상료효、병조전귀급위암루진정황。결과53.01%(176/332)위점막저급별상피내류변환자림상표현위상복은통불괄,83.13%(276/332)환자병조다위우하1/3위,내경하형태각이。소유환자평균수방(14.67±30.99)개월후,경연합치료림상증상총개선솔위76.51%(254/332),병조총소퇴솔위62.95%(209/332)。공검출위암28례,기중부합위암루진혹가능루진자10례(35.71%,10/28)。결론위복춘련용협산능유효완해위점막저급별상피내류변환자적림상증상,부분소퇴저급별류변병조。대위점막저급별상피내류변환자진행정기위경수방유망조기검출위암병조。부분위점막상피내류변동시존유암조,내경단기、중복검사가감소위암루진솔。
Objective To discuss the outcomes of the diagnosis,treatment and follow-up protocols of low-grade gastric intraepithelial neoplasia (LGIEN).Methods From January 2009 to December 2012, the clinical data of 332 patients with LGIEN confirmed by endoscopic biopsy in the digestive clinic of Rui Jin Hospital were collected.All the patients received pharmacotherapy with Weifuchun and folic acid.Regular follow-ups and endoscopic reviews were carried out to monitor the outcomes and to learn the instance of gastric cancer misdiagnosis.Patients received endoscopic or surgical treatment or pathological examination when necessary. Results The most common symptom of LGIEN patients was epigastric discomfort (53.01%,176/332).The lesions were mainly located in the low third part of stomach (83.13%,276/332) and the endoscopic appearances were variform.After a (14.67 ±30.99)months follow-up in average,the overall improvement rate of clinical symptoms was 76.51% (254/332),and the overall regression rate of lesions was 62.95% (209/332).Twenty-eight cases of gastric cancer were detected,of which 10 cases (35.71%,10/28)met the criterion of misdiagnosis or possible misdiagnosis.Conclusions Weifuchun combined with folic acid therapy can effectively relieve the clinical symptoms of LGIEN patients and partially extinguish the lesions.Patients with LGIEN may have cancer coexisted,so periodic and standardized gastroscopy follow-up must be carried out in order to reduce the missed diagnosis rate of gastric cancer.