胃镜下无恶变征象的胃巨大溃疡145例诊疗分析

目的探讨胃镜下无恶变征象的胃巨大溃疡的发病趋势和特点、诊断性治疗的价值、内镜诊断与病理诊断的相关性。方法收集2005～2013年间胃镜诊断胃巨大溃疡、无典型恶变特征、且首次活检病理未报告"癌"的住院患者145例,均接受抗溃疡加抗幽门螺旋杆菌(Helicobacter pylori,H.pylori)四联疗法,分析其多次胃镜检查的转归及病理诊断的变化。结果胃镜下无恶变征象的胃巨大溃疡年均检出率为5.63%,无明显增高趋势,男性明显高于女性;总恶变率为45.52%,其恶变与性别、部位、大小和形态无相关性(P0.05),但与年龄、H.pylori感染相关(P0.01)。2次胃镜诊断巨大溃疡与病理诊断符合率分别为55.86%和98.62%。结论胃镜下无恶变征象胃巨大溃疡的恶变与性别、部位、大小和形态无关,但与H.pylori感染正相关,且41～70岁年龄段高发,诊断性治疗联合多次胃镜活检是其定性诊断的最佳方法。

Diagnosis and treatment of atypical malignant huge gastric ulcer by gastroscopy

Objective The aim of this study is to identify the incidence trend and characteristics of atyp-ical malignant huge gastric ulcer, the value of diagnostic treatment, the relationship between endoscopic and pathologic diagnosis. Methods One hundred and forty five hospitalized patients with atypical malignant huge gastric ulcer diagnosed by gastroscopy during 2005 ~2013 were collected,and biopsy was not reported as＆quot;cancer＆quot;at the first time, and all patients were subject to anti-ulcer and anti-Helicobacter pylori with quadruple chemotherapy. Changes of endoscopic appearance and results of pathological diagnosis were analyzed. Re-sults Average annual detection rate of atypical malignant huge gastric ulcer was 5.63%, and the incidence was not increased annually. Total malignant transformation rate was 45.52%, and male was significantly higher than female. There was no significant relationship between canceration and gender, position, size and shape （P＆gt;0.05）, except age and Helicobacter pylori infection （P＆lt;0.01）. The coincidence rate of huge gastric ulcer di-agnosed by endoscopy and pathological examination was 55.86%（first time） and 98.62%（second time）, re-spectively. Conclusions The malignant transformation from atypical malignant huge gastric ulcer to cancer was not related to gender, position, size and shape, except age of 41~70 years old and Helicobacter pylori in-fection. The best practice to identify atypical malignant huge gastric ulcer was the diagnostic therapy combined with multiple gastroscopy.