目的 探讨天津某地区胃部癌前病变、良恶性肿瘤的病理学特征及其发病规律。方法 提取天津市某三级综合医院2014-07至2024-08期间28 110例胃镜检查病理诊断结果,分析疾病谱特点,以及癌前病变、胃癌发病部位、病理类型、分化程度、性别、年龄等临床、病理特征。结果 28 110例胃镜检查病理诊断病种主要包括炎症性疾病(检出率68.25%)、良性肿瘤和恶性肿瘤3大类,胃炎症性疾病共19 186例,其中慢性萎缩性胃炎占35.72%(6 854/19 186),慢性非萎缩性胃炎占63.46%(12 176/19 186),均好发于胃窦;良性肿瘤7 587例,其中息肉占93.73%(7 111/7 587),息肉易在胃体/胃角部位检出;恶性肿瘤716例,腺癌占胃镜恶性肿瘤的72.07%(516/716)、间质瘤占22.77%(163/716);低、中-低分化腺癌平均年龄64.00(56.00,71.00)岁,中、中-高分化腺癌平均年龄(70.04±9.38)岁,两组年龄差异有统计学意义(P<0.05),胃癌全年龄段男性检出率高于女性,低、中-低分化腺癌在60岁之前检出率高于中、中-高分化腺癌;胃异型增生检出3 720例,检出率为13.23%(3 720/28 110),高级别异型增生(HGD)平均年龄(63.35±10.31)岁,低级别异型增生(LGD)平均年龄59.00(51.00,66.00)岁,两组年龄间差异有统计学意义(P<0.05);肠上皮化生检出9 922例,检出率为35.30%(9 922/28 110),平均年龄59.00(51.00,65.00)岁。结论 该地区胃恶性肿瘤以腺癌和间质瘤常见,建议该地区人群,特别是男性(>40岁或更早)常规定期进行胃镜检查,早期发现、早期干预,从而降低其发病率。

Objective To explore the pathological features and incidence patterns of gastric precancerous lesions, and benign and malignant tumors in the stomach region of a certain region of Tianjin. Methods The pathological diagnosis results of 28110 cases of gastroscopy from a tertiary general hospital in Tianjin from July 2014 to August 2024 were extracted. The features of the disease spectrum, as well as the lesion sites, pathological type, differentiation degrees, gender, age, etc. of precancerous lesions and gastric cancer were analyzed. Results The main types of diseases diagnosed by gastroscopy included inflammatory diseases (68.25%), benign tumors and malignant tumors. There were 19186 cases of gastric inflammatory diseases, among which chronic atrophic gastritis accounted for 35.72% (6 854/19 186) and chronic non-atrophic gastritis for 63.46% (12 176/19 186), all of which were more common in the gastric antrum. Among the 7 587 cases of benign tumors, polyps accounted for 93.73% (7 111/7 587). Among the 716 cases of malignant tumors, adenocarcinoma accounted for 72.07% (516/716) and gastrointestinal stromal tumors accounted for 22.77% (163/716). The average age of patients with low and low-to-moderately differentiated adenocarcinoma was 64.00 (56.00, 71.00) years, while that of patients with moderately and moderately-to-highly differentiated adenocarcinoma was 70.04±9.38 years.The age difference between the two groups was statistically significant (P＜0.05). The detection rate of gastric cancer in males was higher than that in females, and the detection rate of low and low-to-moderately differentiated adenocarcinoma was higher than that of moderately and moderately-to-highly differentiated adenocarcinoma before the age of 60. Gastric dysplasia was detected in 3,720 cases, with a detection rate of 13.23% (3,720/28,110). The average age of high-grade dysplasia (HGD) was 63.35±10.31, and that of low-grade dysplasia (LGD) was 59.00 (51.00, 66.00) years. The age difference between the two groups was statistically significant (P＜0.05). Intestinal metaplasia was detected in 9,922 cases, with a detection rate of 35.30% (9,922/28,110), and the average age was 59.00 (51.00, 65.00) years. Conclusions Gastric malignant tumors in the area of Tianjin are mainly adenocarcinoma and stromal tumors. It is recommended that people in this region, especially males (over 40 years old or earlier), should regularly undergo gastroscopy for early detection and intervention to reduce the incidence.