72例早期胃癌的诊断、治疗及预后分析

Diagnosis and treatment of early gastric carcinoma

目的探讨早期胃癌(early gastric carcinoma,EGC)的诊断、治疗及影响预后的因素。方法回顾性分析1995年6月至2002年6月我院EGC的临床资料。结果本组EGC共72例,肿瘤部位:贲门部1例,胃体13例,胃窦56例,双原发癌2例(胃窦加胃体,胃窦胃大弯加胃小弯)。黏膜内癌42例,黏膜下癌30例。肿瘤病理分型:低分化腺癌24例,中分化腺癌17例,高分化腺癌 5例,印戒细胞癌12例,低分化腺癌部分印戒细胞癌12例,局部黏膜癌变2例。淋巴结转移10例。 EGC患者多因上腹疼痛首诊。上消化道X线造影、B超、CT的EGC检出率分别为57％、3％和15％。胃镜检查68例,病理确诊率94％。全部患者接受D2胃癌根治术,18例术后化疗。1例肝、肺转移行导管介入治疗,1例骨转移。随诊0．5-9年,随诊率85％,5年生存率90％,死亡率3％。结论根治性手术治疗是EGC取得良好疗效的最佳途径。D2胃癌根治术是治疗EGC的标准术式。胃镜病理活检是EGC诊断的金标准。淋巴结转移率是影响EGC预后的主要因素。

Objective To evaluate the diagnosis, treatment and prognosis of early gastric carcinoma（EGC）. Methods Clinical data of 72 EGC cases from June 1995 to June 2002 were retrospectively analyzed. Results There were 54 males, 18 females ; the mean age was 55.2 years （ 28 72）. Tumor was located in the cardiac in one case, in the body of stomach in 13 cases, in the gastric antrum in 56 cases, multifocal in 2 cases （ gastric antrum and body, gastric antrum with lesser and greater curvature invasion in one each）. Pathological feature： 24 cases were of poor differentiation, 17 cases of moderate differentiation, 5 cases of high differentiation, 12 cases of signet-ring cell carcinoma, 12 cases of poor differentiation with slgnet-rlng cell carcinoma, 2 cases of local mucosal cancerization. Mucosal tumors were classified in 42 cases, submucosal in 30 cases, 10 cases had lymph-node metastases. The most common symptom was pain in epigastrium, followed by nausea, vomit, anorexia, emaciation and tary stool. GI series detected 57.1% of cases. B-us and CT detected 2.8% and 15.3% respectively. Gastroscopy was the most effective way for diagnosis, with the diagnostic accuracy of 94%. All patients received operation of D2-lymphadenectomy, 70 cases underwent distal subtotal gastrectomy, 1 case did proximal subtotal gastrectomy, 1 case did total gastrectomy. One case had bone metastasis, one case had liver and lung metastasis. Follow-up was made from 0.5 to 9 years, follow-up rate was 84. 8% , 5-year survival rate was 90%. Conclusion Pathological diagnosis by gastroscopy is the gold standard. D2 gastrectomy is the standard surgical treatment. The metastasis rate of the lymph nodes is the independent prognostic factor.