伴充血的早期胃癌内镜形态与病理的比较研究

Comparison between endoscopic appearance and pathology of early gastric cancer with focal hyperemia or redness

目的对内镜下伴有显著病灶周边或中央充血、发红的早期胃癌患者，对其内镜形态学特征及手术病理结果开展比较研究，以了解两者关联并提高常规内镜检查的诊断价值。方法回顾分析上海瑞金医院2006年6月～2007年9月共107例早期胃癌的内镜下形态特征，其中病灶周边或病灶中央具有显著充血、发红改变者共28例患者纳入本次研究范畴，着重观察其病灶充血发生的部位、表面形态以及病灶边缘形态；核实其手术病理所示癌组织分化程度、浸润深度及淋巴结转移情况，并与形态学治疗对比。结果伴充血的早期胃癌按其充血的形态和相对位置可分为三类：1型为凹陷型病变周围不规则栅状充血；2型为浅表凹陷型病变中央出现红色充血颗粒及小结节；3型表现为浅表隆起型病变伴充血腺瘤样增生。28例患者中1型17例（60．7％），2型7例（25．0％）；3型4例（14．3％）。不同充血形态与癌组织分化程度存在明显关联，其中1型充血改变以分化型癌为多（10／17，58．8％）；3型均为分化型（4／4，100％）；而2型几乎均为未分化型（6／7，85．7％）。结论胃浅表型病变伴黏膜充血发红样改变，常为早期胃癌的特殊改变。充血发红灶的发生部位及背景病变同癌组织的分化程度存在明显关联，结合病变边缘轮廓、发生部位等信息，可进一步提高内镜检查对早期胃癌的预测价值。

Objective To investigate the relation gastric cancer with obvious focal hyperemia or redness between endoscopic morphology and surgical pathology on early around or in the middle of the lesion so as to enhance diagnostic value of routine endoscopy. Methods From June 2006 to September 2007,endoscopic data of a total 107 consecutive patients with surgically proved early gastric cancer were reviewed. A total of 28 patients with obvious focal hyperemia or redness around or in the center of the cancerous lesion were recruited in the study. Detailed investigations were focused on the distribution and appearance of the redness and the fringe of the entire lesion. Tumor differentiation, invasion depth and lymph node metastasis proved by surgery were studied and compared with endoscopic findings. Results All lesions could be classified into the following by appearance and distribution of the hyperemia or redness of the lesion：a depressed lesion surrounded by irregular palisade-like hyperemia （type 1 ） ; red granules in the background of a superficial depressed lesion （ type 2） ; adenoma-like hyperemia in the background of a superficial elevated lesion （type 3 ）. Among 28 patients,type 1 was confirmed in 17 patients （60.7%） ; type 2 in 7 patients （25.0%） and type 3 in 4 patients （14.3%）. Remarkable relation was found between different types of redness and tumor differentiation, as differentiated gastric cancer was frequently associated with type 1 （10/17,58.8%） and type 3 （4/4,100%） while undifferentiated gastric cancer was closely related with type 2 （6/7,85.7%）. Conclusion Focal hyperemia or redness observed in superficial gastric lesions can be particular changes associated with early gastric cancer. The distribution and background changes of the spots are closely related to tumor differentiation and when integrated with contour, location and other features of the lesion, it will further enhance the diagnostic value of routine endoscopy on early gastric cancer.