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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。
Objective To explore the possibility of magnifying endoscopy for the diagnosis of atrophic gastritis, precancerous lesions and Helicobacter pylori (Hp) infection. Methods One hundred and forty patients with different gastric diseases were examined with Olympus GIF Q-240Z magnifying endoscopy and histopathological examination was performed on the observed sites to investigate the relationship between the two. Results (1) The morphology of gastric mucosa can be divided into five basic types (type A), type B (short rod), type C (dendritic), type D (plaque) and type E Types of. (2) The rate of endoscopic diagnosis of atrophic gastritis was 94.3% (33/35) in magnifying endoscopy, compared with 22.8% (8/35) in general endoscopy (P <0.01). (3) Fourteen cases (77.8%) of 18 cases of complete intestinal metaplasia showed villiform and finger-like changes (type E) under magnifying endoscopy, whereas only 13 cases of incomplete intestinal metaplasia (30.8%) showed E-shaped changes (P <0.05), the remaining 9 cases were C or D type. (4) The morphology of inferior vena cava can be divided into R type (regular type), I type (irregular type) and D type (disappeared type). The infection rates of the three types of Hp were 12.2% (9/74) , 60.0% (9/15) and 84.3% (43/51) respectively. There was significant difference between R type and I type or D type (P <0.01). Conclusion Enlarging endoscopy has great diagnostic value on gastric mucosal atrophy, intestinal metaplasia and Hp infection.