内镜检查慢性萎缩性胃炎与病理诊断的临床对比观察
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摘要
目的探讨内镜检查对慢性萎缩性胃炎患者的诊断价值并将其与病理诊断结果进行对比。方法回顾性分析2015年4月至2018年2月因消化道症状在我院治疗的101例患者的临床资料,所有入选者均需接受内镜检查以及病理诊断,比较检查结果。结果内镜检查对慢性萎缩性胃炎的诊断灵敏度为78%,过度诊断率(误诊率)为25%;经病理诊断确诊的79例慢性萎缩性胃炎患者发病部位:胃底1例,占1%;贲门下区6例,占8%;胃体8例,占10%;胃角14例,占18%;胃窦50例,占63%。于内镜表现方面,A+B+C(A为黏膜红白相间,但白相为主,皱襞变平或者消失;B为部分黏膜下血管网显露;C为黏膜壁、黏膜粗糙,且黏膜表面不平,且可见结节状或者黏膜颗粒状表现)占比均低于C、A+C、B+C,差异有统计学意义(P<0.05);将病理诊断结果视作标准,内镜检查对A+B+C的诊断符合率最高,其次为B+C、A+C、A+B。结论单独通过内镜检查以诊断慢性萎缩性胃炎尚存在过度诊断或漏诊现象,临床应充分认识该疾病于内镜下呈现的多样性表现,避免主观诊断,此外,将其与病理诊断相结合,利于提高诊断准确率。
Objective To investigate the diagnostic value of endoscopy and pathological diagnosis in patients with chronic atrophic gastritis(CAG). Methods One hundred and one patients with digestive system symptoms treated in the hospital from April 2015 to February 2018 were retrospectively analyzed. All selected cases were given en-doscopy and pathological diagnosis, and the results of examinations were compared. Results The diagnostic sensitivity of endoscopy in CAG was 78%, and the excessive diagnosis rate(misdiagnosis rate) was 25%; among the 79 pa-tients with CAG diagnosed by pathological diagnosis, the pathological sites were as follows: 1%(one case)of the fundus of stomach, 8%(six cases)of the lower part of the cardia, 10%(eight cases)of the gastric body, 18%(fourteen cases) of the gastric angle and 63%(fifty cases) of the gastric antrum; In terms of endoscopic performance, the proportion of A+B+C was lower than that of C, A+C and B+C, respectively and the difference was statistically significant(P<0.05); the pathological diagnosis was regarded as the standard, and the endoscopy had the highest diagnostic accor-dance rate for A+B+C, followed by B+C, A+C, and A+B. Conclusion Simple endoscopy in the diagnosis of CAG still has excessive diagnosis or missed diagnosis. The clinical manifestation of the disease should be fully recognized under endoscopy, avoiding subjective diagnosis. In addition, combining it with pathological diagnosis is beneficial to improve the diagnostic accuracy.
Objective To investigate the diagnostic value of endoscopy and pathological diagnosis in patients with chronic atrophic gastritis(CAG). Methods One hundred and one patients with digestive system symptoms treated in the hospital from April 2015 to February 2018 were retrospectively analyzed. All selected cases were given en-doscopy and pathological diagnosis, and the results of examinations were compared. Results The diagnostic sensitivity of endoscopy in CAG was 78%, and the excessive diagnosis rate(misdiagnosis rate) was 25%; among the 79 pa-tients with CAG diagnosed by pathological diagnosis, the pathological sites were as follows: 1%(one case)of the fundus of stomach, 8%(six cases)of the lower part of the cardia, 10%(eight cases)of the gastric body, 18%(fourteen cases) of the gastric angle and 63%(fifty cases) of the gastric antrum; In terms of endoscopic performance, the proportion of A+B+C was lower than that of C, A+C and B+C, respectively and the difference was statistically significant(P<0.05); the pathological diagnosis was regarded as the standard, and the endoscopy had the highest diagnostic accor-dance rate for A+B+C, followed by B+C, A+C, and A+B. Conclusion Simple endoscopy in the diagnosis of CAG still has excessive diagnosis or missed diagnosis. The clinical manifestation of the disease should be fully recognized under endoscopy, avoiding subjective diagnosis. In addition, combining it with pathological diagnosis is beneficial to improve the diagnostic accuracy.
引文
[1]房静远,陈萦,高琴琰.重视慢性萎缩性胃炎癌变的预警、早诊与预防[J].中华消化杂志,2018,38(3):145-148.
[2]纪文静,阿里木江·阿不杜热合曼,丁永年.窄带成像结合放大内镜在慢性萎缩性胃炎诊断中的应用[J].中国现代医学杂志,2017,27(5):86-88.
[3]刘文娟,原丽莉.内镜检查发现慢性萎缩性胃炎合并胃癌的临床分析[J].中国药物与临床,2016,16(4):550-552.
[4]解朝莉.慢性萎缩性胃炎120例胃镜下表现与病理诊断对照分析[J].中国药物与临床,2018,18(8):1378-1379.
[5]苏振华,魏思忱,王亮,等.窄带成像放大内镜诊断慢性萎缩性胃炎的价值[J].胃肠病学,2015,20(11):676-679.
[6]邱晓娣,潘翔珍,梁群英,等.慢性萎缩性胃炎内镜检查与临床病理诊断对比研究[J].临床与病理杂志,2015,35(11):1954-1957.
[7]袁索红,周红兵.观察慢性萎缩性胃炎内镜诊断与病理结果对照分析[J].中国伤残医学,2015,23(16):115-116.
[8]李兴,刘立玺,唐琳,等.内镜下窄带成像以及胃黏膜血红蛋白的指数技术在慢性萎缩性胃炎诊断中的应用[J].中国内镜杂志,2015,21(8):806-809.
[2]纪文静,阿里木江·阿不杜热合曼,丁永年.窄带成像结合放大内镜在慢性萎缩性胃炎诊断中的应用[J].中国现代医学杂志,2017,27(5):86-88.
[3]刘文娟,原丽莉.内镜检查发现慢性萎缩性胃炎合并胃癌的临床分析[J].中国药物与临床,2016,16(4):550-552.
[4]解朝莉.慢性萎缩性胃炎120例胃镜下表现与病理诊断对照分析[J].中国药物与临床,2018,18(8):1378-1379.
[5]苏振华,魏思忱,王亮,等.窄带成像放大内镜诊断慢性萎缩性胃炎的价值[J].胃肠病学,2015,20(11):676-679.
[6]邱晓娣,潘翔珍,梁群英,等.慢性萎缩性胃炎内镜检查与临床病理诊断对比研究[J].临床与病理杂志,2015,35(11):1954-1957.
[7]袁索红,周红兵.观察慢性萎缩性胃炎内镜诊断与病理结果对照分析[J].中国伤残医学,2015,23(16):115-116.
[8]李兴,刘立玺,唐琳,等.内镜下窄带成像以及胃黏膜血红蛋白的指数技术在慢性萎缩性胃炎诊断中的应用[J].中国内镜杂志,2015,21(8):806-809.
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