青年人原发性胃恶性肿瘤462例分析

Analysis of 462 Young Patients with Primary Malignant Tumors in Stomach

目的:探讨青年人原发性胃恶性肿瘤临床病理特点及诊治方法。方法:对462例患者临床病理资料进行系统性回顾。结果:青年人原发性恶性肿瘤主要为胃癌,少数为原发性淋巴瘤、平滑肌肉瘤等。青年人胃癌组织分化差的类型居多,易发生浸润和转移,远端胃为好发部位;常规胃镜加活检低于中老年人胃癌的诊断水平,超声内镜、胃镜结合超声诊断符合率明显高于常规胃镜检查;根治性切除术者1年、2年、5年生存率明显高于姑息性手术者,早期胃癌根治性切除效果更佳。青年人原发性胃淋巴瘤诊断时以中晚期居多,根治性切除术亦有较好的疗效。结论:青年人原发性胃恶性肿瘤恶性程度高,预后差;早期发现和早期手术切除是提高生存率的关键;胃镜是诊断胃恶性肿瘤的主要方法,超声内镜、胃镜结合超声可提高诊断率,尤其是对于胃壁浸润者。

Objective：To investigate the characteristics of clinicopathology and the methods of diagnosis and treatment of primary malignant tumors in stomach of young patients. Methods： The clinical and pathological features of 462 young patients with primary malignant tumors in stomach were analyzed retrospectively. Results： Most （85.0%） of the 462 cases were gastric carcinoma. The gastric carcinoma of young patients had the pathologic features such as poor differentiation, early infiltration and metastasis, more originating from the distal part of stomach, and more foci involved （versus that of the elderly）. The coincidence rates of endoscopic ultrasonography and ultrasonograpgy combined with gastroscopy in diagnosing gastric carcinoma in youth were 100% and 94.2% respectively, and both were higher than those of conventional gastroscopy and biopsy （71.8%）. The 1-, 2- and 5-year survival rates of radical resection cases were 54.3%, 31.5% and 19.7% respectively, and were higher than those of palliative operation ones （27.3%, 10.4%, and 0, respectively）; the 5-year survival rate of 27 early-stage cases with radical resection reached 100%. Most of the young cases of primary gastric lymphoma were diagnozed in the middle and late stages. Seven of the 11 cases with radical resection combined with chemotherapy and radiotherapy survived after a 5-year follow-up. Conclusion： The differentiation and prognosis of primary gastric malignant tumors in youth are poor, and the metastases happen early. Early diagnosis and early radical resection is important to improve survival rate. The conventional gastroscopy is major method in diagnosing gastric malignant tumors, but endoscopic ultrasonography and ultrasonography combined with gastroscopy may elevate the coincidence rate of diagnosis.