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目的:探讨放大胃镜下黏膜微血管改变对早期胃癌的诊断价值。方法:收集215例常规胃镜观察下有胃黏膜粗糙、糜烂、斑块、颜色异常、微隆或凹陷等改变的患者及20例健康志愿者,应用放大胃镜观察,根据胃镜下黏膜微血管改变将放大胃镜下黏膜像分为4型。对病变区取活检送病理检查,将胃镜结果与组织病理诊断对照研究后进行统计学分析。结果:95%(19/20)健康志愿者符合Ⅱ型微血管改变;80.53%(91/113)Hp相关性胃炎符合Ⅰ型微血管改变;92.86%(13/14)的早期胃癌患者符合Ⅲ型、Ⅳ型微血管改变,应用χ2检验对构成比进行比较,早期胃癌组与正常对照组比较P<0.05,与Hp相关性胃炎组比较P<0.05,差异有统计学意义,其中80.0%的黏膜癌符合Ⅲ型改变,75%的黏膜下癌符合Ⅳ型改变,黏膜癌组与黏膜下癌组比较差异有统计学意义(P<0.05)。结论:微血管改变与组织诊断密切相关,放大胃镜可提高早期胃癌的检出率,且有助于判断癌变浸润深度。
Objective: To explore the value of magnifying endoscopic mucosal microvascular changes in the diagnosis of early gastric cancer. Methods: Totally 215 patients with gastric mucosal rough, erosive, plaque, color abnormalities, micro-lumbar or depression, and 20 healthy volunteers underwent routine gastroscopy were enrolled in the study. According to endoscopic mucosal microvascular changes under endoscopy, Gastroscopic mucosal resection is divided into 4 types. The lesions were biopsied for pathological examination, the results of gastroscopy and histopathological diagnosis control study for statistical analysis. Results: Ninety-five percent (19/20) of the healthy volunteers were eligible for type Ⅱ microvascular changes. 80.53% (91/113) Hp-related gastritis were consistent with type Ⅰ microvascular changes. 92.86% (13/14) Ⅳ microvascular changes, using χ2 test to compare the constituent ratio, early gastric cancer group and the normal control group P <0.05, compared with the Hp-related gastritis group P <0.05, the difference was statistically significant, of which 80.0% of the mucosal cancer coincided Type Ⅲ changes, 75% of submucosal carcinoma with type Ⅳ changes, mucosal cancer and submucosal cancer was significantly different (P <0.05). Conclusion: Microvascular changes are closely related to tissue diagnosis. Enlarging gastroscope can improve the detection rate of early gastric cancer and help to determine the depth of invasion.