| 摘要: |
| 目的:分析胃镜检查时胃黏膜肉眼观察和组织学检查结果之间的相关性,以评估胃镜检查时胃黏膜活检的必要性.方法:收集我院2005年1～12月因上消化道症状在内镜中心接受胃镜检查的门诊患者.选择连贯的病例入组,每组患者包括反流性食管炎、非萎缩性胃炎、萎缩性胃炎、胃溃疡和十二指肠溃疡,同组患者在年龄、性别和病史等方面相互匹配,共320例.胃黏膜肉眼评估由2位有经验的内镜检查医师共同进行,评估的指标包括渗出、充血、糜烂、光滑程度和胃内胆汁反流等;活检组织学检查由同一位病理医师执行,报告的指标包括活动性炎症、慢性炎症、萎缩、肠化生和不典型增生等;幽门螺杆菌(HP)的诊断基于活检标本的快速尿素酶试验、组织改良银染色和组织学检查结果,其中2项以上阳性作为判定标准.结果:HP感染、糜烂、渗出和黏膜粗糙对于活动性炎,HP感染和黏膜糜烂对于慢性炎症,黏膜粗糙对于肠化生,HP感染和黏膜粗糙对于萎缩,陈旧出血点、HP感染、黏膜粗糙和胆汁反流对于不典型增生有一定预测价值.肉眼诊断萎缩性胃炎的正确率仅为71.9％.假阳性率为28.2％;肉眼诊断非萎缩性胃炎的正确率仅为75.62％,漏诊率为34.38％.结论:肉眼观察结果对胃黏膜组织病理学检查结果有一定的提示作用,但预测价值较低,缺乏足够的相关性.内镜下肉眼观察不能代替黏膜组织学检查. |
| 关键词: 内镜、病理学、胃炎、消化道溃疡、肠化生 |
| DOI：10.3724/SP.J.1008.2006.00634 |
| 投稿时间：2006-01-13修订日期：2006-04-17 |
| 基金项目:上海市重点学科建设项目（Y0205）. |
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| Consistency between histopathological results of routine endoscopy and biopsy in observing gastric mucosa of patients with non-malignant gastroduodenal diseases |
| 杨海芸,戈之铮,陈胜良,陈素英,YANG Hai-yun,GE Zhi-zheng,CHEN Sheng-liang,CHEN Su-ying |
| () |
| Abstract: |
| Objective：To analyze the consistency between the histopathological results of routine endoscopy and biopsy in observing the gastric mucosa of patients with non-malignant gastroduodenal diseases, and to evaluate the necessity of biopsy following gastric endoscopy. Methods.. From Jan. 2005 to Dec. 2005, 320 patients who received upper gastrointestinal endoscopy and biopsy because of upper abdominal symptoms were included in this study. The patients were selected consecutively according to their disorders diagnosed by macroscopic endoscopy and were divided into 64 groups. The 5 patients in each group had reflux esophagitis, non-atrophic gastritis, atrophic gastritis, gastric ulcer and duodenal ulcer, respectively. Patients in the same group were matched with each other in gender, age and their history of diseases. The results of endoscopy, including the exudation, congestion, erosion, roughness, bile reflux, etc. , were read by 2 experienced endoscopists. The biopsy was performed by an experienced pathologist and pathological variables included active inflammation, chronic inflammation, atrophy, intestinal metaplasia and atypical hyperplasia. The status of Helicobacter pylori （H. pylori） infection was evaluated by rapid urea test, silver staining and histological methods; the result was deemed positive when the results of either 2 tests were positive. Results： Erosion, exudation, roughness, and H. pylori infection were related with active inflammation; erosion and H. pylori infection were related with chronic inflammation; roughness of mucosa was related with atrophy; roughness and H. pylori infection were related with intestinal metaplasia; and obsolete hemorrhage, H. pylori infection, roughness mucosa, and bile reflux were related with atypical hyperplasia. Macroscopic diagnosis rate of atrophic gastritis was 71.9% （46/64） with a false positive rate of 28.2 % （18/64） and a false negative rate of 34.38% （22/64）. Conclusion： Macroscopic diagnosis is indicative to pathological changes of gastric mucosa, but the predictive value is relatively poor, making biopsy and pathological examination necessary in the diagnosis of gastric mucosa disorders during routine endoscopic examination. |
| Key words: endoscopy pathology gastritis peptic ulcer intestinal metaplasia |
