放大内镜下胃病患者胃黏膜微细结构改变及其临床病理意义

目的 探讨放大内镜用于诊断萎缩性胃炎、癌前病变及幽门螺杆菌(Hp)感染的可能性。方法 对140例不同胃病患者,用Olympus GIF Q-240Z放大内镜进行观察和分型,并在所观察的部位取活组织做病理组织学检查,研究两者之间的相互关系。结果 (1)胃黏膜小凹形态可分为A型(点状)、B型(短棒状)、C型(树枝状)、D型(斑块状)及E型(绒毛状)五种基本类型。(2)萎缩性胃炎的内镜诊断率,放大内镜为94.3％(33/35),而普通内镜仅为22.8％(8/35)(P<0.01)。(3)18例完全型肠上皮化生中有14例(77.8％)在放大内镜下可见绒毛状、指头样改变(E型),而13例不完全型肠上皮化生则只有4例(30.8％)呈E型改变(P<0.05),其余9例均呈C型或D型。(4)胃体下部集合静脉形态可分为R型(规则型)、I型(不规则型)及D型(消失型),三种类型的Hp感染率分别为12.2％(9/74)、60.0％(9/15)和84.3％(43/51),R型与I型或D型比较,差异有显著性(P<0.01)。结论 放大内镜对胃黏膜萎缩、肠上皮化生及Hp感染均有很大诊断价值。

Study on the microstructural changes of gastric mucosa under magnifying endoscopy and their clinicopathological significance

Objective To explore the diagnostic value of magnifying endoscopy in the identification of chronic atrophic gastritis (CAG) , intestinal metaplasia (IM) and Helicobacter pylori ( Hp) infection. Methods Microstructures of gastric mucosa in 140 cases with different gastric diseases were studied using Olympus GIF-Q240Z magnifying endoscope. Biopsies were taken from the magnified sites. The microstruc-tures of gastric mucosa were compared with the results of pathological study. Results The morphology of gastric pits was classified as follows: Types A ( round spot) , B ( short rod) , C ( branched) , D ( patchy) and E ( villous) . The detection rate of CAG by magnifying endoscopy was 94. 3% (33/35) , which was significantly higher than that by routine endoscopy (22. 8% , 8/35) (P < 0. 01 ). Fourteen of 18 cases (77. 8% ) with complete IM have the gastric pits of Type E , whereas only 4 of 13 cases with incomplete IM have this type( P < 0. 05 ) , and the rest 9 cases appeared as C or D type. The morphology of collecting ven-ules was subgrouped into; Types R ( regular) , I ( irregular) and D ( disappeared ) , their Hp infection were found in 12. 2% (9/74) , 60. 0% (9/15) and 84. 3% (43/51 ) respectively. Hp infection rate in Type R was significantly lower than that of other two types ( P < 0.01). Conclusion Magnifying endoscopies may have an obvious value in diagnosing CAG, IM and HP infection.