胃粘膜肠上皮化生的内镜诊断

目的探讨内镜下胃粘膜肠上皮化生诊断的可行性及准确度.方法应用放大或普通型内镜对受检者的胃底、胃体及胃窦进行仔细观察,详细描述肠上皮化生的表现特点并至少于胃窦小弯、大弯及胃体各取活检一块,收集同期病理诊断肠化生的病例并将内镜表现与病理进行对照分析.结果同期病理组织学诊断肠上皮化生患者329例.根据内镜下的特异性肠上皮化生的表现淡黄色结节状、瓷白色小结状、鱼鳞状和弥漫不规则颗粒不平状,内镜诊断肠上皮化生134例,经活检病理证实128例,内镜诊断符合率95.5%.胃粘膜活检诊断而内镜未予诊断者201例,内镜检查诊断肠上皮化生的总符合率38.9%.轻、中、重度肠上皮化生内镜诊断率不同,分别为23.8%、48.5%和51.7%.而放大内镜对轻、中、重度肠上皮化生诊断准确率分别为47.5%、78.5%和75.4%,明显高于普通型内镜组的1.9%、28.6%和34.9%,(P＜0.05),差异有显著意义.结论胃粘膜肠上皮化生内镜表现除淡黄色结节型和粘膜不规则颗粒不平的弥漫型外,尚有鱼鳞状和瓷白色半透明的小结节型,这四种典型的肠上皮化生形态学特征,是内镜诊断肠化生的特异型标志.这四种肉眼形态学特征与病理肠上皮化生程度无关,但肠化生程度与内镜诊断呈平行关系.放大内镜对肠上皮化生诊断率明显高于普通型内镜.

Endoscopic Diagnosis of Intestinal Metaplasia in Gastric Mucosa

Objective To estimate the feasibility and accuracy of endoscopic diagnosi s of intestinal m pieces of biopsy were taken from the lesser curvature of antrum,corpus,and greater curvature of antrum,respectively,in etaplasia(IM). Methods To observe the gastric mucosal patterns in detail with magnifying and routine gastroscope and 3 each patientTo define the main pattern of IM and endoscopic diagnostic rate in comparison with the pathologic result as control. Results Four patterns IM defined as following:yellowish nodules, whitish nodules,fish-scale-like and diffused irregular uneven nodules.The specificity of endoscopic diagnosis as controlled with pathology was 95.5%(128/134),the general sensitivity was 38.9%(128/329).But in the mild,moderate and severe degree of IM,there were different sensitivity,it was 23.8%,48.5% and 51.7% respectively.The sensitivity of magnifying endoscopic diagnosis were 47.5%,78.5% and 75.4% respectively.It was much better than routine endoscopy(P<0.05). Conclusion Endoscopic patterns of IM could be divided into four types: yellowish nodules,whitish nodules,fish-scale-like and diffused irregular uneven nodules.The endoscopic diagnosis rate correlated to the degree of IM.The diagnosis accuracy of magnifying endoscopy is much better than routine endoscopy.