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[目的]对胃黏膜上皮内瘤变(IEN)患者开展胃镜的定期随访和筛查胃癌的研究,探索提高临床胃癌检出的有效性。[方法]收集2009年1月~2014年12月间,经胃镜活检病理诊断为胃黏膜IEN患者505例,其中低级别上皮内瘤变(LGIEN)465例,高级别上皮内瘤变(HGIEN)40例,进行定期随访、胃镜复查及病灶活检病理学检查,病理学证实胃癌或有确切病灶的HGIEN者行外科、腹腔镜手术或内镜黏膜剥离术(ESD)治疗,切除标本作病理学检查及胃癌分期。[结果]505例胃黏膜IEN患者经平均21.33个月的随访以及平均3.88次的胃镜复查,共检出胃癌81例,检出胃癌占全组的16.0%,其中早期胃癌51例,占检出胃癌的63.0%;进展期胃癌22例,占检出胃癌的27.2%。另外经胃镜活检病理检出的8例胃癌失访。465例LGIEN患者,检出胃癌57例(12.3%),其中早期胃癌38例(66.7%);40例HGIEN患者,检出胃癌24例(60.0%),其中早期胃癌13例(54.2%)。[结论]通过对胃黏膜IEN患者的定期胃镜随访及病理活检,能有效提高胃癌的检出率,尤其能够在LGIEN中筛查出漏诊的胃癌患者;具有确切病灶的HGIEN者,手术病理证实大多为胃癌患者,因此对胃黏膜IEN患者的定期复查必须实施制度化管理。
[Objective] To conduct regular follow-up of gastroscopy and gastric cancer screening in patients with gastric intraepithelial neoplasia (IEN), and to explore ways to improve the detection of clinical gastric cancer. [Methods] A total of 505 patients with gastric mucosal IEN diagnosed by gastroscopic biopsy from January 2009 to December 2014 were collected. Among them, 465 cases of low grade intraepithelial neoplasia (LGIEN), 465 cases of high grade intraepithelial neoplasia (HGIEN) Forty patients were followed up, endoscopy and lesion biopsy pathological examination, HGIEN pathologically confirmed gastric cancer or a definite lesion underwent surgery, laparoscopic surgery or endoscopic mucosal dissection (ESD) treatment, the specimens were removed for pathological examination And gastric cancer staging. [Results] The 505 cases of gastric mucosal IEN patients were followed up for an average of 21.33 months and an average of 3.88 times of gastroscopy. 81 cases of gastric cancer were detected, accounting for 16.0% of the total, of which 51 cases of early gastric cancer 63.0% of gastric cancer; 22 cases of advanced gastric cancer, accounting for 27.2% of gastric cancer detected. In addition to pathological biopsies detected by the 8 cases of gastric cancer were lost. Of the 465 patients with LGIEN, 57 (12.3%) were diagnosed with gastric cancer, of which 38 (66.7%) had early gastric cancer and 24 (60.0%) were diagnosed with gastric cancer in 40 HGIEN patients, including 13 (54.2%) of early gastric cancer. [Conclusion] The regular gastric endoscopy and pathological biopsy of IEN patients with gastric mucosa can effectively improve the detection rate of gastric cancer, especially in LGIEN screening patients with missed diagnosis of gastric cancer; HGIEN who have the exact lesion confirmed most of the surgical pathology For gastric cancer patients, therefore, regular review of gastric mucosal IEN patients must implement the institutional management.