极微小胃癌临床病理特征及治疗的探讨

Clinicopathologic study on gastric mini-cancer

目的探讨极微小胃癌的临床病理学特点。方法对2004年1月至2008年6月浙江大学医学院附属第二医院收治的296例早期胃癌患者中肿瘤直径≤10mm的34例早期胃癌的临床病理资料进行回顾性分析，将其中5例直径≤2mm的早期胃癌（极微小胃癌组）与29例直径在2-10mm的早期胃癌（对照组）进行分组比较研究。结果极微小胃癌占同期早期胃癌病例的2％；黏膜内癌在极微小胃癌组和对照组中分别占100％和45％；高、中分化型腺癌在极微小胃癌组和对照组分别占100％和55％；极微小胃癌组淋巴结转移率为0，对照组为3％；极微小胃癌组和对照组均未见脉管浸润；极微小胃癌组和对照组肿瘤表层部与浸润部病理组织学一致率分别为100％（5／5）和86％。结论极微小胃癌常局限于黏膜内，组织学类型比较单一，以高、中分化腺癌为主，不伴淋巴结转移及脉管浸润，浸润部与表层部组织学分化程度较一致。极微小胃癌是内镜治疗的良好适应证。

Objective To investigate the clinicopathological features of mini-cancer of the stomach. Method In this study, out of 296 early gastric cancer cases there were 34 cases of early gastric cancer in which tumor diameter was ≤10 mm, among those there were 5 cases with tumor size ≤2 mm and 29 cases of the size 2 - 10 mm. Result Mini-cancer accunted for 2% of all early gastric cancers in this series; All these mini-cancers were of intramucosal cancer （ 100% ） , while that took up to 45% in control group in which tumors were between ≥2 mm and ≤ 10 mm; Tumors were high or moderately differentiated pathologically in 100% of mini-cancers and 55% in control group. None of mini-cancer patients had lymph node metastasis, however, 1 of 29 patients in control group had lymph node metastasis. Both groups had no blood vessel and lymphatic vessel invasion; The differentiation concordance rate between superficial lesions and invasive fronts in mini-cancer was 100% , higher than 86% in control group. Conclusion Gastric mini-cancer is usually of high differentiation, low tumor invasion and low rate of lympy node metastasis than control group. Endoscopic therapy is applicable for most gastric mini-cancers.