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目的探讨胃腺瘤性息肉的临床特征。方法收集2007年1月至2015年5月温州医科大学附属第一医院所有胃腺瘤性息肉患者的临床资料并进行总结分析。结果胃镜检查发现胃腺瘤性息肉患者78例,占同期全部胃镜检查患者数的0.026%,以中老年多见。临床常以上腹不适(31/78,39.7%)、上腹痛(8/78,10.3%)、胃食管反流症状(4/78,5.1%)等非特异性表现行胃镜检查而发现。胃镜下,胃腺瘤性息肉多位于胃体(19/78,24.4%)或胃窦(39/78,50.0%),呈现单发(59/78,75.6%)或2~5枚(15/78,19.2%),≤20 mm(71/78,91.0%)的广基黏膜隆起,息肉形态大部分呈山田Ⅰ型(44/78,56.4%)、Ⅱ型(29/78,37.2%)。病理表现为密集排列拥挤的增生旺盛的腺体,常伴有周围黏膜形态学和组织学异常,其中伴萎缩性胃炎9例(9/78,11.5%),肠上皮化生7例(7/78,9.0%),胃腺癌1例(1/78,1.3%)。15例胃腺瘤性息肉患者同时完成了结肠镜检查,结直肠肿瘤检出率高达66.7%(10/15)。同期行胃肠镜检查而胃镜示无胃腺瘤性息肉并且性别年龄匹配的对照组中结直肠肿瘤检出率为17.8%(8/45)。两组间差异有统计学意义(χ2=9.626,P=0.002)。17例患者术后定期随访,其中3例患者复查时胃镜及病理提示腺瘤性息肉复发。结论胃腺瘤性息肉临床症状缺乏特异性,有癌变的风险,可以合并胃内其他病变,在正确处理胃息肉的同时,应重视周围胃黏膜的变化,且应重视术后随访及结直肠肿瘤的筛查。
Objective To investigate the clinical features of gastric adenomatous polyps. Methods The clinical data of all patients with gastric adenomatous polyps from January 2007 to May 2015 in the First Affiliated Hospital of Wenzhou Medical University were collected and analyzed. [Results] Gastroscopy found 78 cases of gastric adenomatous polyps, which accounted for 0.026% of the total number of gastroscopy patients in the same period, more common in the elderly. Clinical non-specific symptoms such as abdominal discomfort (31/78, 39.7%), epigastric pain (8/78, 10.3%), gastroesophageal reflux symptoms (4/78, 5.1%), etc. were found by gastroscopy. Under gastroscopy, gastric adenomatous polyps were mostly found in the stomach (19/78, 24.4%) or antrum (39/78, 50.0%), presenting solitary (59/78, 75.6%) or 2 to 5 (15/ (78, 19.2%), ≤ 20 mm (71/78, 91.0%) wide mucous membrane uplift, polyp morphology mostly Yamada I (44/78, 56.4%), II (29/78, 37.2%) . The pathology is characterized by dense and crowded hyperplasia of the glands, often accompanied by surrounding mucosal morphological and histological abnormalities, including 9 cases with atrophic gastritis (9/78, 11.5%), 7 cases of intestinal metaplasia (7/ 78,9.0%), 1 case of gastric adenocarcinoma (1/78, 1.3%). Fifteen patients with gastric adenomatous polyps also completed colonoscopy. The detection rate of colorectal neoplasms was as high as 66.7% (10/15). The incidence of colorectal neoplasms was 17.8% (8/45) in the control group with gastroenteroscopy and endoscopy without gastric adenomatous polyps. There was a statistically significant difference between the two groups (χ2=9.626, P=0.002). Seventeen patients were followed up at regular intervals. Gastroscopy and pathology at the time of reexamination showed recurrence of adenomatous polyps in 3 patients. Conclusion The clinical symptoms of gastric adenomatous polyps lack specificity, have the risk of canceration and can be combined with other gastric lesions. In the correct treatment of gastric polyps, attention should be paid to changes in the surrounding gastric mucosa, and postoperative follow-up and colorectal tumors should be considered Screening.