上消化道同时性多原发癌28例胃镜检查和临床特征分析

Analysis of Endoscopic and Clinical Features of 28 Cases of Multiple Synchronous Upper Gastrointestinal Cancer

背景:上消化道同时性多原发癌(SC)的发病率正逐渐上升,目前缺乏对其内镜特点和临床特征的认识,极易漏诊,延误治疗。目的:分析上消化道SC的胃镜和临床特点,提高早期诊断率。方法:对内镜下可疑病灶采用染色、放大观察,多点取材病理检查,对管腔狭窄者应用超细胃镜检查,并回顾性分析患者的相关临床特征。结果:3183例上消化道恶性肿瘤共中检出上消化道SC28例,占0.9%。其中年龄>40岁且有腹痛、饱胀、烧心、吞咽不畅等非特异性症状者19例(67.9%);有食欲减退、体质量减轻、贫血等报警症状者3例(10.7%);有上消化道肿瘤高危因素者5例(17.9%)。结论:可疑人群的色素放大内镜、超细胃镜检查对上消化道SC的早期诊断有重要意义。

The incidence of multiple synchronous upper gastrointestinal cancers is increasing gradually. Misdiagnosis and delayed treatment often occur because of failure in recognition of its endoscopic and clinical features. Aims： To analyze the endoscopic and clinical features of 28 cases of multiple synchronous upper gastrointestinal cancers so as to improve the early diagnosis rate. Methods： Magnification chromoendoscopy was performed at suspicious lesion and pathologic examination of multiple biopsy specimens was done, small diametric endoscope was used for narrowed luminal cases and associated clinical features were analyzed retrospectively. Results： Out of 3183 patients with upper gastrointestinal malignant tumors, 28 （0.9%） were diagnosed to have multiple synchronous upper gastrointestinal cancers. There were 19 patients （67.9%） 〉40 years of age with non-specific symptoms including abdominal pain, abdominal distension, heartburn and difficulty in swallowing and 3 patients （10.7%） with warning symptoms of decreased appetite, loss of body weight and anemia. Another 5 patients （17.9%） had high risk factors of upper gastrointestinal cancers. Conclusions： Magnified chromoendoscopy and small diametric endoscope are useful for the early diagnosis of multiple synchronous upper gastrointestinal cancers in suspected patients.