西藏地区内镜检出胃癌367例临床分析

Clinical analysis of 367 cases of gastric cancer detected by endoscopy in Tibet

目的分析西藏高原地区胃癌的临床、内镜及组织学特征。方法总结2018年10月至2020年9月在西藏大学附属阜康医院消化内镜室接受胃镜检查,并病检确诊的367例胃癌患者,对患者的性别、年龄、民族、职业、幽门螺杆菌感染情况,及肿瘤分布部位、内镜分型和组织学分类进行分析。结果胃癌总检出率为3.4%,其中早期胃癌检出率0.06%。男女总检出率分别为3.6%和2.8%,差异有统计学意义(P<0.05)。36~60岁胃癌患者占59.4%,≥61岁占36.2%,≤35岁占4.4%,3个年龄段胃癌检出率分别为0.5%、4.8%和4.7%,差异有统计学意义(P<0.05)。不同民族、职业检出率之间差异无统计学意义(P>0.05)。胃癌患者幽门螺杆菌阳性率(81.4%)高于非胃癌患者幽门螺杆菌阳性率(66.3%),差异有统计学意义(P<0.05)。男女胃癌好发部位均为胃窦幽门,随后男性依次为胃体、贲门胃底、胃角和全胃,女性依次为胃角、胃体、贲门胃底和全胃,差异有统计学意义(P<0.05)。男女不同部位比较得出,男性贲门胃底占比高于女性,而女性胃角占比高于男性,差异有统计学意义(均P<0.05),而男女之间胃窦幽门、胃体和全胃占比差异无统计学意义(P均>0.05)。Borrmann分型以Ⅲ型超半数,其次为Ⅳ型、Ⅰ型和Ⅱ型,男女之间差异无统计学意义(P>0.05)。组织学分型以乳头状腺癌、管状腺癌、黏液腺癌、腺癌占96.1%,印戒细胞癌3.3%,腺鳞癌及未分化癌各占0.3%,绝大多数分化类型为低分化。结论西藏地区胃癌好发于胃窦幽门,内镜下以浸润溃疡型为主,肿瘤组织分化差,临床分期较晚,早期胃癌检出率低,应进一步增强胃癌防治措施。

Objective To analyze the clinical,endoscopic,and histological features of gastric cancer in Tibet.Methods A total of 367 cases of gastric cancer diagnosed by endoscopy at Fukang Hospital Affiliated to Xizang University from October 2018 to September 2020 were included retrospectively.Sex,age,nationality,occupation,Helicobacter pylori(H.pylori)infection status,tumor distribution,endoscopic classification,and histological classification were analyzed.Results The total detection rate of gastric cancer was 3.4%,and the detection rate of early gastric cancer was 0.06%.The total detection rates of gastric cancer among men and women were 3.6%and 2.8%,respectively(P<0.05).There were 59.4%middle-aged people,36.2%elderly people,and 4.4%young people,and the detection rates of gastric cancer in the three age groups were 0.5%,4.8%,and 4.7%,respectively(P<0.05).There was no significant difference in the detection rate among different nationalities and occupations(P>0.05).The positive rate of H.pylori infection in patients with gastric cancer(81.4%)was higher than that in patients without(66.3%;P<0.05).The antral pylorus was the most commonly affected site in both genders,followed by the gastric body,cardia,gastric fundus,gastric angle,and whole stomach in males,and the gastric angle,gastric body,cardiac fundus,and whole stomach in females(P<0.05).The proportion of patients with involvement of the cardia and gastric fundus was higher in males than in females,while the proportion of patients with involvement of the gastric angle was higher in females than in males(P<0.05).More than half of cases were classified as having Borrmann typeⅢ,which was followed by typeⅣ,typeⅠ,and typeⅡ.There was no significant difference between in Borrmann type distribution between males and females(P>0.05).Histologically,papillary adenocarcinoma,tubular adenocarcinoma,mucinous adenocarcinoma,and adenocarcinoma accounted for 96.1%of all cases,Signet ring cell carcinoma accounted for 3.3%,and adenosquamous carcinoma and undifferentiated carcinoma accounted for 0.3%each.The vast majority of patients had poorly differentiated tumors.Conclusion Gastric cancer in Tibet usually occurs in the antral pylorus,is endoscopically mainly infiltrating and ulcerative types,and has poor differentiation,advanced clinical stage,and low detection rate.The prevention and treatment measures of gastric cancer in Tibet should be further strengthened.