贲门组织体内癌变规律的内镜研究(英文)

Public Screening for Early Carcinoma of Gastric Cardia: Rule of Carcinogenetic Development Observed by Endoscopy

目的研究早期贲门癌在体内的发生规律。方法在食管癌高发现场建立前瞻性研究队列(106人),定期普查,利用内镜检查的方法,前后对照式地观察贲门癌高发位点贲门脊根部粘膜变化情况,在相同区域咬取相同块数的活检组织。活检组织经中性福尔马林液固定,常规脱水,石蜡包埋,切片,HE染色,做病理学检查。结果4年后,本组106人,8例贲门粘膜正常者,3例正常,4例出现慢性胃炎,1例发生粘膜内癌;61例慢性胃炎,11例出现腺上皮萎缩,4例发生腺上皮轻度不典型增生,2例腺上皮高度不典型增生;9例腺上皮萎缩病例,5例无变化,4例变为慢性胃炎;22例腺上皮轻度不典型增生,17例消退,4例无变化,1例进展为腺上皮高度不典型增生;1例腺上皮高度不典型增生变为轻度不典型增生;5例未经任何治疗的粘膜内癌,1例成为浸润癌,1例仍为早期癌,3例变为贲门粘膜轻度不典型增生。结论早期贲门癌发生经历慢性胃炎、腺上皮萎缩、不典型增生几个癌前阶段;早期贲门癌和癌前病变在体内处于动态的可复性的变化过程中。

Objective： To study the rule of development of early cancer of gastric cardia in vivo in public screening. Methods： A prospective cohort study on gastric cardiac cancer was performed in the high incidence area of cancer of esophagus and stomach in china. 106 subjects had been examined regularly by endoscopy to observe the change of mucosa in high incident area of gastric cardiac carcinoma developing at the root of gastric cardiac ridge by taking biopsy specimen. All specimens were diagnosed through normal pathological process to study the prognosis of pro-cancer lesions of gastric cardia. Results： The results of 106 subjects who had been observed for 4 years were： （1） Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. （2） Of 61 persons with chronic gastritis, 11 were observed to have gland atrophy, 4 mild atypical hyperplasia, and 2 highly atypical hyperplasia. （3） Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. （4） Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. （5） One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. （6） Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early cancer stage, and 3 turned to atypical hyperplasia. Conclusion： The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, gland atrophy, and atypical hyperplasia. （2） The early cancer and pre-cancer lesions of gastric cardia is reversible, though possessing malignant possibility.