早期胃癌的内镜表现特点分析

Endoscopic Diagnosis and Clinical Analysis of Early Gastric Cancer

目的总结早期胃癌内镜下表现特点,以提高早期胃癌的内镜诊断率。方法回顾性分析2007年5月—2009年10月经外科手术证实和内镜下切除证实的144例早期胃癌患者的临床资料,总结其内镜下表现特点。结果本组早期胃癌患者术前常规内镜检查确诊124例,超声内镜检查确诊20例。病变部位以胃窦部(46例,31.9%)最多,其次是胃角部(44例,30.6%)、胃体部(24例,16.7%)、贲门部(14例,9.7%)及胃底(16例,11.1%)。肉眼观察以Ⅱ型(表面型)(105例,72.9%)为主,其中Ⅱa型34例,Ⅱb型15例,Ⅱc型56例;其次是Ⅲ型(溃疡型)(24例,16.7%)和I型(隆起型)(15例,10.4%)。本组病例1次内镜检查确诊100例(69.4%),2次或2次以上内镜检查才确诊44例(30.6%)。结论早期胃癌以Ⅱ型病变多见,且胃窦部为好发部位,内镜检查及黏膜多点活检为早期确诊的主要手段;另外,超声内镜检查也有助于早期胃癌的诊断及治疗方法的选择。

Objective To analyze the feature of endoscopic diagnosis and clinical characteristic of early gastric cancer to raise the correct rate of diagnosis.Methods Analyze retrospectively the clinical data of 144 patients from May 2007 to October 2009 with early gastric cancer confirmed by operation and endoscopic resection to summarize the endoscopic feature of the disease.Results 124 patients with early gastric cancer were diagnosed by preoperative gastroscope examination,and 20 patients were diagnosed by ultrasonic endoscope.31.9%（46/144） of the tumors were located in the antrum and 30.6%（44/144） were in the angulus.Type Ⅱ（105/144,72.9%）is predominant,among which 34 cases were type Ⅱa,15 cases type Ⅱb and 56 cases type Ⅱc.Type Ⅲ was found in 24 cases（16.7%） and type I in 15 cases（10.4%）.100 patients were diagnosed by one gastroscope examination,and 44 were diagnosed by two or more gastroscope examinations.Conclusion Type Ⅱ is common in patients with earth gastric cancer and the predilection site is in the antrum.The main diagnosis method is gastroscope examination combining multiple punch biopsies.Endoscopic ultrasonography is helpful to the diagnosis and theraphy of early gastric cancer.