早期胃癌临床筛选的现状和进展

Current status and advances in screening of early gastric cancer

经过三十多年的努力,中国部分医疗中心早期胃癌手术率已达15%～20%,但与日本等国尚存明显差距。日本早期胃癌中约40%无临床症状,而我国单从临床症状人群中筛选早期胃癌显然不够,必须放宽胃镜及胃X线钡餐检查指证,并适时开展胃癌普查工作。胃黏膜高级别上皮内瘤变(HGIEN)包括上皮重度不典型增生和原位癌,内镜下有确切病灶者,可予内镜下切除或外科手术治疗。放大内镜、共聚焦内镜及经内镜固有荧光光谱检测等新技术有助于诊断早期胃癌。组建跨学科、跨专业的学科群,是增进各科合作及共同提高我国早期胃癌手术率的重要途径。

As a result of constant effort in the past thirty years, the surgical proportion for the early gastric cancer has reached 15% - 20% in some medical centers in China. Yet it is still greatly lagging behind in this field compared with Japan and some other advanced nations. In the thought of 40% of asymptomatic patients in all the patients with early gastric cancer in Japan, it is far from sufficient to screen for early gastric cancer in symptomatic patients only. Expanding the indications for endoscopy and upper GI barium examination is strongly recommended and large-scale screening for early gastric cancer among the general public should be conducted while appropriate. High-grade intraepithelial neoplasia （HGIEN） of gastric mucosa consists of high-grade dysplasia and carcinoma in situ. Patients with tangible lesions and a pathological diagnosis of HGIEN are right candidates for endoscopic resection or surgery. Clinical application of magnifying endoscopy, confocal microendoscopy and endoscopic laser-induced fluorescence spectroscopy is beneficial in early diagnosis of gastric cancer. Developing an interdisciplinary and intersubdisciplinary platform is a critical way to fascilitate collaboration and enhance early diagnosis of gastric cancer.