2024 年第 3 期 第 19 卷

胃增生性息肉的临床和内镜及病理特征分析

Clinical, endoscopic and pathological characteristics analysis of gastric hyperplastic polyps

作者：张冬雪丁士刚张静

英文作者：Zhang Dongxue Ding Shigang Zhang Jing

单位：北京大学第三医院消化内科幽门螺杆菌感染及上胃肠疾病防治研究北京市重点实验室，北京100191

英文单位：Department of Gastroenterology Peking University Third Hospital Beijing Key Laboratory for Prevention and Treatment Research of Helicobacter Pylori Infection and Upper Gastrointestinal Diseases Beijing 100191 China

关键词：胃息肉；增生性息肉；内镜特征；病理特征；背景胃黏膜；癌变

英文关键词：Gastricpolyps;Hyperplasticpolyps;Endoscopiccharacteristics;Pathologicalcharacteristics;Backgroundgastricmucosa;Carcinogenesis

• 摘要：

• 目的 分析胃增生性息肉（GHP）的临床、内镜和病理特征。方法 回顾性分析北京大学第三医院2005年1月1日至2021年12月31日经胃镜及病理学检查确诊为GHP的4 010例患者的临床、内镜及病理资料。结果 4 010例GHP患者年龄（58±14）岁，其中女性2 522例（占62.9%），>50～60岁、>60～70岁为高发年龄段，分别为1 106例（27.6%）、1 076例（26.8%）。合并幽门螺杆菌感染者795例（19.8%）；GHP单发者2 811例（70.1%），好发部位为胃体（1 456例、36.3%）、贲门（880例、21.9%）及胃窦（697例、17.4%），形态学分型以山田Ⅰ型为主、2 401例（59.9%），Ⅱ型也相对较多、931例（23.2%）。2 278例（56.8%）患者息肉直径≤0.5 cm；GHP肠化发生率为5.5%（221/4 010），异型增生发生率为3.1%（124/4 010），癌变发生率为0.3%（12/4 010）。GHP背景胃黏膜中，慢性浅表性胃炎占52.0%（2 083/4 010），慢性萎缩性胃炎占25.9%（1 040/4 010），其中慢性萎缩性胃炎伴肠化755例、占总体的18.8%，自身免疫性胃炎430例（10.7%），存在异型增生333例（8.4%），合并胃癌共37例（0.9%）。结论 GHP多为单发，好发于胃体，息肉存在发生异型增生及癌变的可能性；对于体积较大的息肉，内镜检查时应警惕其恶变可能。

• Objective To explore the clinical, endoscopic and pathological characteristics of gastric hyperplastic polyps(GHP). Methods The clinical, endoscopic, and pathological data of 4 010 patients diagnosed with GHP through gastroscopy and pathological examination at Peking University Third Hospital from January 1, 2005 to December 31, 2021 were retrospectively analyzed. Results The age of 4 010 GHP patients was (58±14) years, of which 2 522 were female(62.9%), with a high incidence rate of 1 106 cases (27.6%) and 1 076 cases (26.8%) aged >50-60 and >60-70 years, respectively. There were 795 cases (19.8%) complicated with Helicobacter pylori infection; GHP was often solitary in 2 811 cases (70.1%), with the most common site being the gastric body, 1 456 cases (36.3%), 880 cases (21.9%) of the cardia, and 697 cases (17.4%) of the gastric antrum. Morphological classification was mainly Yamada type Ⅰ, 2 401 cases (59.9%), and type Ⅱ was relatively common in 931 cases (23.2%). There were 2 278 patients (56.8%) with polyp diameters ≤0.5 cm; the incidence of GHP intestinal metaplasia was 5.5%(221/4 010), the incidence of dysplasia was 3.1%(124/4 010), and the incidence of cancer was 0.3%(12/4 010). In the GHP background gastric mucosa, chronic superficial gastritis accounted for 52.0%(2 083/4 010), and chronic atrophic gastritis accounted for 25.9%(1 040/4 010). Among them, 755 cases of chronic atrophic gastritis accompanied by intestinal metaplasia accounted for 18.8% of the total, 430 cases(10.7%) of autoimmune gastritis, 333 cases(8.4%) of atypical hyperplasia, and 37 cases(0.9%) of gastric cancer. Conclusion Most GHP are solitary, distributed in the stomach body, and polyps have the possibility of dysplasia and canceration. For large polyps, endoscopic examination should be wary of the possibility of malignant change.