内镜下白醋喷洒对胃黏膜肠化的诊断价值探讨.docVIP

内镜下白醋喷洒对胃黏膜肠化的诊断价值探讨 宁夏医学杂志2010年3月第32卷第3期NingxiaMedJ,Mar.2010,Vol32,No.3 文章编号:1001—5949(2010)03—0228—03?论着? 内镜下白醋喷洒对胃黏膜肠化的诊断价值探讨 梁俊荣,杨力 [摘要]目的探讨胃镜下白醋喷洒对胃黏膜肠化诊断的价值.方法139例内镜诊断慢性萎缩性胃炎及浅 表性胃炎的病例,应用1.5%白醋喷洒胃窦部黏膜,1min后观察其黏膜形态的变化并记录,同时在其改变最明显的 部位靶向活检进行病理检查.结果64例病理证实萎缩性胃炎的病例中,伴肠化者35例,伴不典型增生者8例, 喷洒自醋后29例伴肠化及5例伴不典型增生者白化明显,21例单纯萎缩性胃炎中6例白化明显,余未见明显白 化;胃小凹以Ⅳ型改变为主,仅2例伴肠化者表现为Ⅲ型.70例浅表性胃炎中伴肠化的21例中有19例白化明显, 49例不伴肠化的浅表性胃炎中3例白化明显;伴肠化者胃小凹改变主要为Ⅳ型,不伴肠化者以Ⅱ型改变为主;胃癌 以Ⅵ型改变为主.胃黏膜白化的改变中,伴肠化组明显高于不伴肠化的浅表性胃炎和萎缩性胃炎,有统计学意义. 结论内镜下对胃黏膜喷洒白醋,伴肠化及不典型增生的胃窦黏膜白化明显,胃小凹形态一过性发生变化,有助于 指导靶向活检,可提高胃黏膜肠化及早期胃癌的诊断率. [关键词]白醋;肠化 [中图分类号]R573.4[文献标识码]A Thevalueofwhitevinegarstaininginthediagnosisofgastricintestinalmetaplasia LlANGJun—rong,YANGLi.(TheAffiliatedHospitalofNingxiaMedicalUniversity,Yinchuan750004,China) [Abstract]ObjectiveToinvestigatethevalueofwhitevinegarstaininginthediagnosisofgastricintestinalmetaplasia(IM). Methods139patientswithatrophicandsuperficialgastritiswereenrolled.1.5%whitevinegarweresprayedontheirantrummucosa. whilethegastricpitsandwhiteeffectwereobserved.Thebiopsysamplesweretakenonthewhiteeffectsites.Results64casesofa— trophicgastritisareconfirmedpathologically,theantrummucosaof29/35withIM,5/8withdysplasiaand6/21withoutIManddyspla— siahassignificantwhiteeffect.Themucosalpitsof62patientswithatrophicgastritisweretype1V.2weretypellI.70casesofSH- perficialgastritis,19/21withIMand3/49withoutIMhaveobviouswhiteeffect.Thegastricpitsof19/21withIMweretypeIV,41/ 49withoutIMweretypelI.4/5patientsofgastriccancerweretypeVI.ThepatientswithIMwerehigherwhiteeffectthansuperfi? cialgastritisandatrophicgastritiswithoutIManddysplasia.Therewerestatisticallysignificant.ConclusionStainingwhitevinegaron thegastricmucosaunderendoscopy,thepatientswithIManddysplasiahasobviouswhiteeffect,andthegastricpitscanbeshown clearlytransientlywhichcanguidetargetedbiopsyandbeusefulforthediagnosisofgastricintestinalmetaplasiaandearlygastriccancer. [Keywords]Whitevinegar;Intestinalmetaplasia 胃黏膜肠化是指胃黏膜表层被复上皮或腺上皮 为肠上皮所代替的一种病理过程.胃黏膜肠化被认 为