胃息肉,到底要不要斩草除根?

2018-04-28 阿杜 胃肠病

”胃息肉”这一名称通常只表示肉眼所观察到的隆起物,是胃黏膜表面长出的乳头状突起,多是由胃黏膜异常增生而来。

”胃息肉”这一名称通常只表示肉眼所观察到的隆起物,是胃黏膜表面长出的乳头状突起,多是由胃黏膜异常增生而来。

较小时常无明显症状,一般都是在胃镜检查、胃肠钡餐造影或其他原因手术时偶然发现。

本病早期或无并发症时多无症状。出现症状时常表现为上腹隐痛、腹胀、不适,少数可出现恶心、呕吐。

合并糜烂或溃疡者可有上消化道出血,多表现为粪潜血试验阳性或黑便,呕血少见。

位于幽门部的带蒂息肉,可脱入幽门管或十二指肠,而出现幽门梗阻的表现。息肉生长于贲门附近时可有吞咽困难。



消化内科门诊,经常看到这样的胃镜报告:“胃息肉”。很多患者看到这样的报告,以为自己得了胃癌,常为此焦虑不安。

那么胃息肉究竟是怎么回事?需要怎么治疗? 胃里怎么会长息肉,会不会癌变?需不需要切除呢?

为什么会长息肉?

胃息肉是一种公认的胃癌癌前期病变。

据统计,约有1-5%的胃镜受检者中可发现息肉,其中约80%为炎性或增生性息肉,约20%为腺瘤性息肉。



胃息肉

目前,对胃息肉的病因及发病机制仍不完全清楚,初步研究提示:

1.增生性息肉或炎性息肉通常是由于胃内感染和损伤引起的适应性反应,如幽门螺杆菌(H. p)感染,在中国感染率达57%~75%,H. p阳性的增生性息肉患者在成功根除H. p感染后,其中约40%的患者息肉完全消退;



2.而腺瘤性息肉和H. p感染关系不明确,它的发生多与基因突变有关,可能是由

于外界或环境因素改变而导致多个基因改变造成的。

3.家族性息肉有家族史或遗传可能。

4.药物疾病原因:某些药物长期刺激胃粘膜而发生息肉;

5.也有报道称质子泵抑制剂长期服用也会刺激产生;

6.此外,胃食管返流症等疾病也会引起息肉发生。

胃息肉无症状易被忽视

随着人们健康意识的提高,体检越来越受重视,做胃镜检查的人也越来越多,所以胃息肉的发现率逐年增高。

除非胃息肉过大或位置特殊,如长在幽门处导致幽门梗阻等,绝大多数胃息肉几乎不会引起人体的不适症状,如不做胃镜检查,很容易被人们忽视。

但由于胃息肉有恶变可能,且个别胃息肉恶变几率很高,患者一旦忽视很可能罹患胃癌,所以建议应重视胃镜检查。

此外,老年人胃病发病率高,如胃溃疡、胃炎等,会经常服用抑制胃酸分泌的药物。

虽然抑酸药物对于治疗胃病非常有效,但同时也增加了胃息肉的患病可能,所以老人们在胃病治愈后,一定要及时停药,千万不要滥用,否则可能治好了原有的胃病,招来了新的胃病。

胃息肉会癌变吗?癌变几率有多大?

患者在被查出胃息肉后,最关心的问题就是“会不会癌变”?

胃息肉是一种公认的胃癌癌前期病变。

增生性息肉癌变率低约为0-5%;

腺瘤性息肉癌变率高一般在25-50%之间,甚有高达66.5%的报告。

但胃息肉发生癌变受到诸多因素的影响,如息肉的大小、组织学类型、形态、数目、部位、上皮间变程度、年龄以及地区和种族等;并非所有的息肉都会癌变。

①息肉的大小:

呈正相关,即息肉越大,癌变率越高。

直径小于1.0厘米的有蒂息肉癌变率 小于1%;

直径在1-2厘米者癌变率通常为10%;

直径大于2厘米的癌变率通常为50%。

②息肉的组织学类型:

腺瘤性息肉癌变率高,其中管状腺瘤的癌变率为1-5%,绒毛状腺瘤的癌变率最高约为10-60%,而混合性息肉癌变率则介于两者之间。

也有人将息肉的表面发生重度不典型增生称之为"原位癌",这时异常细胞仅局限于上皮的表面而未侵犯到腺体的基底膜。

③息肉的形态:

有蒂息肉癌变率较低而无蒂息肉癌变率高。

息肉表面光整者癌变率小于5%,呈乳头状者约近35%,呈菜花状或分叶状者约为50%。

无蒂息肉如表面不光整且呈中凹花坛状易癌变。

④息肉的部位与年龄:

胃息肉的多发部位是胃窦约占65%,其次为胃体部约占20%。

一般认为多发性息肉的癌变率高于单发者;

年龄越大息肉发生机会越多癌变率越高;

腺瘤存在的时间越长,癌变的危险性越大。

⑤多发性息肉的恶变率比单个息肉高。

⑥增生性息肉癌变率较低

也叫炎性息肉或再生性息肉,属于胃腺体增生延长,排列比较紊乱,腺体之间有较大的空隙,有的中间夹有未成熟的细胞,绝大多数无不典型增生,癌变率只有0.4%左右。

所以,所有类型的息肉,胃镜一经发现,应必须取活检,做活检的目的就是通过病理证实息肉是腺瘤性息肉还是增生性息肉,如果是腺瘤性息肉,原则上需要切除治疗,以绝后患;

如果是增生性息肉,依据病因,采取相应措施。

到底要不要切除?

患者发现胃息肉后,应观察胃息肉的大小、形态和数目:

1、如胃息肉直径小于1厘米,且数目较少,可先定期监测。通常建议50岁以上患者每年做一次胃镜检查,观察息肉生长状况,如没有长大和增多倾向,则可继续观察。也可以在内镜下行切除术。

2、如息肉直径在1~2厘米之间,通常认为可切可不切,但是如数目较多,则建议切除,尤其是息肉无蒂,属腺瘤型息肉,则一定要切除。

1~2厘米的息肉可在胃镜下切除,无需另做手术,所以患者不必有太大心理负担。

3、如息肉直径大于2厘米,则不论息肉多少、类型、有蒂无蒂,一定要切。此类息肉最好通过腹腔镜手术切除,通过胃镜切除很容易切漏,而一旦切漏,后续处理非常麻烦。

镜下切除息肉过程



结语

总之,一旦在胃镜下发现息肉,不管有无症状,主流观点是:

第一,必须取活检;

第二,视息肉的形态和数目等因素,考虑胃镜下切除。

第三,对于恶变率较高的息肉建议立即胃镜下、腹腔镜、或外科手术切除。

第四,即使切除后,还需定期内镜复查,1-2年一次胃镜复查。

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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-08-02 zehuiwang

    学习了,写得很清楚,有个问题请教,增生性息肉(伴低级别腺上皮内瘤变)与腺瘤性息肉有何区别呢

    0

  2. 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-05-05 122a2221m76暂无昵称

    好!

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  3. 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2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310279, encodeId=2ea33102e989, content=谢谢了.学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Sun Apr 29 06:43:06 CST 2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310056, encodeId=2b8d31005621, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Sat Apr 28 08:49:50 CST 2018, time=2018-04-28, status=1, 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-29 aids217
  4. 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-29 一个字-牛

    学习了谢谢分享

    0

  5. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310043, encodeId=1f01310043ab, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sat Apr 28 08:07:09 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310039, encodeId=d35a310039f7, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-29 txqjm

    谢谢了.学习

    0

  6. 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 明月清辉

    谢谢分享.学习了

    0

  7. 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2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310279, encodeId=2ea33102e989, content=谢谢了.学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=30331616752, createdName=txqjm, createdTime=Sun Apr 29 06:43:06 CST 2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310056, encodeId=2b8d31005621, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Sat Apr 28 08:49:50 CST 2018, time=2018-04-28, status=1, 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 飛歌

    学习了很有用

    0

  8. 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 龙胆草

    学习谢谢分享

    0

  9. 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 sunfeifeiyang

    0

  10. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310043, encodeId=1f01310043ab, content=学习了很有用, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib3IzoRn621JdKCFUI4XvNELcibocrAVU6aUzEVDSaf3rYH08PUYUiagGqxAEhj8g9WqqNvD1CupIpCrmnR2OrqHZh/0, createdBy=7f181365728, createdName=飛歌, createdTime=Sat Apr 28 08:07:09 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310039, encodeId=d35a310039f7, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, 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createdName=衣带渐宽, createdTime=Sat Apr 28 07:19:22 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 衣带渐宽

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