166例早期胃癌的诊治分析

Diagnosis and Treatment of 166 Patients with Early Gastric Cancer

目的总结早期胃癌的诊治经验。方法回顾性分析1999年1月至2009年1月在北京协和医院收治的166例病历资料完整的早期胃癌患者的临床、手术及病理资料,随访患者的治疗结果,对相关数据进行统计学分析。结果早期胃癌手术病例占同期全部胃癌手术病例的9.04%（176/1946）。166例患者中,查体发现异常9例,29例（17.47%）有明确胃溃疡或慢性胃炎病史,20例（12.05%）有胃食管癌症家族史;64例行上消化道双对比造影检查,57例（89.06%）有异常发现;胃镜显示远端胃部、胃体部、胃底部病变分别为115例（69.28%）、26例（15.66%）,25例（15.06%）。手术范围小于或等于D1者126例,D1＋以上者40例。术后病理显示病变平均直径为（2.52±1.62）cm,肿瘤局限在黏膜内者75例（45.18%）,侵及黏膜下者91例（54.82%）;淋巴结转移20例（12.05%）,均为病变侵及黏膜下层者（20/91,21.98%）;脉管瘤栓8例。术后总体5年生存率为87.9%;无淋巴结转移和有淋巴结转移者的5年生存率分别为89.7%和70.0%,差异有统计学意义（P=0.002）。单因素分析结果显示,浸润深度（P=0.000）和脉管瘤栓（P=0.001）与早期胃癌淋巴结转移相关;多因素分析结果显示,脉管瘤栓与淋巴结转移显著相关（OR=15.67,95%C：I 3.40~72.14）。结论早期胃癌占全部胃癌手术比例较低,淋巴结转移是影响治疗结局的重要因素。完善早期胃癌术前分期,明确肿瘤浸润深度,采取适当的、规范治疗是疗效的重要保证。

Objective To summarize our experiences in the diagnosis and treatment of early gastric cancer（EGC）.Methods The clinicopathological data of the 166 EGC inpatients who were treated in our hospital from January 1999 to January 2009 were retrospectively analyzed and their treatment outcomes were followed up.Results Surgical treatment for ECG accounted for 9.04%（176/1946） among all the surgeries performed for gastric cancers.Among the analyzed 166 cases,9 asymptomatic patients were diagnosed by routine examination,29（17.47%） had a history of gastric ulcer or chronic gastritis,and 20（12.05%） had a family history of esophageal or gastric cancer.Of 64 patients who received double-contrast gastric X-ray examination,57 patients（89.06%） were found to be with abnormalities.Endoscocpy revealed lesions in lower third,middle third,and upper third of the stomach in 115 patients（69.28%）,26 patients（15.66%）,and 25 patients（15.06%）,respectively.A total of 126 patients received D0 or D1 operations and 40 patients received operations more than D＋1 operation.As shown by post-operative pathological examinations,the mean diameter of the lesions was（2.52±1.62） cm;75 patients（45.18%） had mucosal gastric cancer,91（54.82%） had submucosal gastric cancer,20 patients with submucosal gastric cancer had lymph node metastasis,and 8 patients had lymphatic vessel involvement.The overall 5-year survival rate was 70.0% and 89.7% among patients with or without lymph node metastasis（P=0.002）.Univariate analysis revealed that depth of tumor invasion（submucosa） and lymphatic vessel involvement were significantly correlated with lymph node metastasis（P=0.000,P=0.001）.Multivariate analysis showed that lymphatic vessel involvement was significantly correlated with lymph node metastasis（odds ratio： 15.67;95% confidence interval,3.40-72.14）.Conclusions The proportion of EGC patients undergoing gastrectomy is relatively low among all gastric cancer patients.Lymph node metastasis is a key prognostic factor for EGC.A proper staging of gastric cancer,a precise evaluation of the depth of infiltration,and appropriate and standardized treatment are important to improve the outcomes.