胃癌临床诊断影响因素的探讨

Endoscopy Biopsy and Cytological Smears for Clinic Diagnosis of Gastric carcinomas

目的:探讨影响胃癌临床诊断的因素。方法:对472例胃癌病例的首发症状、内镜、病理组织活检及细胞学刷片检查结果进行回顾性研究,全部病例均行胃镜和组织活检,81例同时行细胞学刷片。结果:病变部位以胃窦(35.4％)和胃体分布(29％)多见,病变主要表现为溃疡(41.8％)、糜烂(16.1％)、菜花样肿物(15.7％)或结节隆起病变(26.5％)。368例(78.1％)在行首次内镜取材活检后确诊,73例(15.5％)需行2次或2次以上的内镜活检,尚有31例(6.5％)需借助其它检查才得以确诊。癌的检出与病灶组织取材量密切相关,每例病灶组织活检量在6块以上时,阳性率可达97.5％,而取材量不足2块时,恶性病变的阳性率仅63.6％。细胞学刷片检查对胃癌检出的阳性率不高(54.3％),但确能在某些组织活检阴性病例中发现恶性细胞。结论:由于胃癌表现的不典型性,对临床就诊病人应注意胃癌的可能。对可疑病变行多块活组织检查(>6块)和同时进行细胞学刷片,对提高胃癌的检出率有重要价值。

472 cases of gastric carcinomas from 1990 to 1998 diagnosed in Nanfang hospital were analyzed for their symptoms,endoscopic finding,biopsy histopathological evaluation and cytological identification.Methods:All patients were carried out for gastroscopy and biopsy,and 81 of them simultaneously for cytological smear examination.Results: By the endoscoy,lesions were mainly located at antrum (35.4%) and corpus (29%),which appeared ulcer (41.8%), erosion (16.1%),cauliflower like mass (15.7%) and nodular rigidity (26.5%).78.15% was diagnosed in first en- doscopic biopsy and 15.5% in the second or the third.Yet 6.5% couldn't be confirmed with endoscopy biopsy.97.5% cancer could be identified if six or more tissues were taken for biopsy,while only 63.6% could be found with less than 2 tissues.Though cytological examination was not sensitive to gastric cancer (54.3%),it certainly helped inthe identifi- cation of the maligency lesions in negative biopsy gastric cancer cases.Conclusions:The study showed that the diagnosed rate or cancer was related with the number of biopsy tissues.