进展期残胃癌29例内镜和内镜超声分析

Endoscopic and Endoscopic Ultrasonographic Features of Advanced Gastric Remnant Cancer:Report of 29 Cases

目的阐明残胃癌(RGC)的内镜和内镜超声声像图特征,提高RGC诊断水平。方法回顾性分析皖南医学院弋矶山医院内镜中心2000年6月-2010年6月间经病理确诊为RGC患者的病例资料,分析进展期RGC的内镜和内镜超声声像图特征。结果共计1127例残胃患者接受内镜检查,其中29例符合RGC诊断标准(检出率为2.57%),均为进展期。其中,男性24例,女性5例(4.8∶1);平均年龄为(64.83±10.35)岁(36～82岁)。因良性病变行胃大部切除术后5年以上的RGC患者26例,平均年龄(65.39±10.87)岁;因恶性病变手术后10年以上残胃发生的RGC患者3例,平均年龄(60.67±6.66)岁,两组年龄之间差异无统计学意义(P>0.05)。不同术式中残胃病变出现的部位比较差异有统计学意义(P<0.001)。4种不同Borrmann分型出现在上消化道不同部位比较差异有统计学意义(P<0.001);不同Borrmann分型性别比较无差异;4种不同Borrmann分型和3种不同术式之间有关联(P=0.002);4种不同Borrmann型和残胃癌前病变之间有关联(P=0.001)。6例进展期RGC患者接受了EUS检查,主要声像图特征为消化道管壁层次结构破坏、管壁增厚、呈低回声改变,EUS可显示病变侵犯深度和周围脏器、淋巴结转移情况。结论内镜下进展期RGC以BorrmannⅡ和Ⅲ为主,Borrmann分型在不同术式和不同残胃癌前病变中的表现不同,受累部位以残胃贲门、残胃小弯和后壁多见。EUS可用于评估RGC的进展情况。

Objective To explore the endoscopic and endoscopic uhrasonographic features of the advanced gastric remnant eancer（RGC）. Methods The data of the patients with RGC were collected and analyzed retrospectively. All the patients received endoscopic or endosconographic examinations in Yijishan hospital of Wannan Medical College Medical from June 2000 to February 2010 RGC. Results Total of 1127 cases of remnant stomach patients with endoscopy, of which 29 patients were advanced according to the diagnostic criteria RGC（ detection rate was 2.57% ） ,24 males cases and 5 females cases（4.8： 1 ）, mean age was （64.83 ± 10.35 ） years;There were 26 cases （26/29） received subtotal gastrectomy because of benign lesion 5 years ago, the mean age was（65.39 ± 10.87） years;while 3 eases（3/29） received surgical treatment due to malignant disease 10 years ago, the mean age was（60.67 ± 6.66） years, the difference between the two groups was not significant（ P 〉 0. 05 ）. The difference in the distribution of lesion sites was statistically significance for the different operation types （P 〈 0.001 ）. In the 4 different Bor- rmann types, the lesion sites in upper digestive tract were statistically significance（ P 〈 0.001 ）, but not for the ages. The 4 differ- ent Borrmann types correlated to the operation types （P = 0. 002 ） and the precancerous lesions （P = 0. 001 ）. 6 eases with ad- vanced RGC received EUS examination, and the main imaging features were the structural damage of digestive tract wall,thicken- ing with hypoechoic changes. EUS showed the invasion depth and the metastasis to the organs and lymph nodes around. Conclusion Borrmann Ⅱ and Ⅲtype RGC account for most of the advanced RGC under endoscopic detection. Different Borrmann types showed various changes in different operation types and different precancerous lesions, the cardia,lesser curvature and posterior wall of the remnant stomach were the main lesion sites. EUS can be used to assess the progress of RGC.