老年人早期胃癌85例临床及内镜诊断

CLINICAL AND ENDOSCOPIC DIAGNOSIS OF 85CASES OF EARLY GASTRIC CANCER IN THE AGED

目的回顾性分析８５例老年人早期胃癌的临床及内镜资料，以提高其诊断水平。方法将我院１９８９年－１９９９年经内镜诊断早期胃癌８５例，从性别、临床特点、病理分型、病灶大小、内镜下分型等方面进行分析。结果老年人早期胃癌男性６８例，女性１７例，年龄６０～９１岁，平均年龄６９．５岁。临床多见不规则的上腹隐痛、饱胀、食欲减退、吞咽不适、消瘦、黑便等非特异性症状。病变部位：胃窦癌３６例；胃体癌１６例；胃角癌１８例；胃底癌５例；贲门癌１０例。内镜下分型：Ⅰ型１例，Ⅱａ型７例，Ⅱｂ型４例，Ⅱｃ型４９例，Ⅱｃ ＋Ⅲ型３例，Ⅱａ ＋Ⅱｃ型１８例，Ⅱｃ ＋Ⅱａ型３例。结果凹陷型最多，平坦型较少见。病灶大小：小于５毫米的微小胃癌１０例；５～１０毫米２５例；１１～２０毫米３５例；大于２０毫米１５例。病理类型：重度不典型增生伴灶性癌变１４例；高分化腺癌１０例；中分化腺癌３８例；低分化腺癌１２例；粘液腺癌１１例。结论（１）对临床上不规则的中上腹痛、腹胀、乏力、纳差或首发黑便或大便隐血阳性、吞咽不适等症状的患者应予做胃镜检查，以排除早癌可能，尤其是有胃部疾病的老年人应扩大内镜检查指征，以提高老年人早癌的检出率。（２）要重视对癌前病变的定期随访?

Objective To study the clinical and endoscopic data of 85cases of early gastric cancer in the aged ret-rospectively in order to improve the ability of diagnosis.Methods 85cases of early gastric cancer diagnosed by endoscopy in our hospital from 1989to 1999were an alysed in respect to sex,clinical features,histologic pattern,size of the lesion,pattern under endoscope,etc.Results The average age of 85cases(68males and 17females,60-91Y)was 69.5years old.Clinically,patients usually had some non -specific symptoms ,such as mild epigastric pain,distention,anorexia,dyspha-gia,weight loss,melena,etc.As to the distribution of the lesions:36were in antrum,16in corpus,18in angulus,5in fundus and 10in cardia.Macroscopic types u nder endoscope:1case was typeⅠ,7casesⅡa,4casesⅡb,49casesⅡc,3casesⅡc +Ⅲ,18casesⅡa +Ⅱc,and 3casesⅡc +Ⅱa.About the size of lesions:10cases were less than 5mm,25cases 5～10mm,35cases 10～20mm,15cases more than 20mm.Histologic p attern were as following:severe dysplasia acompanied by focal carcinogenesis 14cases,well differentiated 10,moderately differentiated 38,poorly differentiated 12and mucinous adenocar-cinoma 11.Conclusions 1.Clinically,endoscopic examination should be su ggested to every patient with such sy mptoms as irregular abdominal pain,distention,fatigue,anorexia,melena and fecal occult blood positi ve recently,dysphagia etc.The in-dications of endoscopic examinatio n must be widened in elderly patients especially.2.Attention must be paid to the follow-up examination of precancerous lesion s,especially,to those people with polyp,gastric ulcer,atrophic gastritis,intestinal metaplasia or severe dysplasia.They should be r anked as high risk group and followed up regularly and closely.3.The abil ity to recognise and distinguish early gastric cancer under endoscope should b e improved,and it must be emphasized that multip le sites and repeated biopsies under endoscope are needed in suspicious cases.