505例胃黏膜上皮内瘤变患者中筛查胃癌的研究

Study on gastric cancer screening in 505 patients with gastric intraepithelial neoplasia

[目的]对胃黏膜上皮内瘤变（IEN）患者开展胃镜的定期随访和筛查胃癌的研究,探索提高临床胃癌检出的有效性。[方法]收集2009年1月~2014年12月间,经胃镜活检病理诊断为胃黏膜IEN患者505例,其中低级别上皮内瘤变（LGIEN）465例,高级别上皮内瘤变（HGIEN）40例,进行定期随访、胃镜复查及病灶活检病理学检查,病理学证实胃癌或有确切病灶的HGIEN者行外科、腹腔镜手术或内镜黏膜剥离术（ESD）治疗,切除标本作病理学检查及胃癌分期。[结果]505例胃黏膜IEN患者经平均21.33个月的随访以及平均3.88次的胃镜复查,共检出胃癌81例,检出胃癌占全组的16.0%,其中早期胃癌51例,占检出胃癌的63.0%;进展期胃癌22例,占检出胃癌的27.2%。另外经胃镜活检病理检出的8例胃癌失访。465例LGIEN患者,检出胃癌57例（12.3%）,其中早期胃癌38例（66.7%）;40例HGIEN患者,检出胃癌24例（60.0%）,其中早期胃癌13例（54.2%）。[结论]通过对胃黏膜IEN患者的定期胃镜随访及病理活检,能有效提高胃癌的检出率,尤其能够在LGIEN中筛查出漏诊的胃癌患者;具有确切病灶的HGIEN者,手术病理证实大多为胃癌患者,因此对胃黏膜IEN患者的定期复查必须实施制度化管理。

[Objective]To explore the diagnostic rate of gastric cancer in patients with gastric intraepithelial neoplasia（GIEN）and analyze its clinical value in enhancing the diagnostic level of early gastric cancer.[Methods]Data of 505 patients with gastric IEN confirmed by endoscopic biopsy were analyzed in the digestive clinic of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine and Ruijin North Hospital from January 2009 to December 2014.Among all patients enrolled,465 patients were diagnosed as low grade intraepithelial neoplasia（LGIEN）and 40 patients as high grade intraepithelial neoplasia（HGIEN）.All patients received regular follow-ups,gastroscopy,pathological biopsy and treated by endoscope or surgery when necessary.[Results]An average of 3.88follow-ups in a period of 21.33 months was achieved.Gastric cancer was eventually diagnosed in 81 patients（16.0%）,among which 51 patients（63.0%）were early gastric cancer,22 advanced gastric cancer（27.2%）of gastric cancer detection,and the rest 8 were lost in the follow-up.In 465 LGIEN patients,gastric cancer was detected in 57 patients（12.3%）,among which 38 were early cancer（66.7%）.In 40 HGIEN patients,gastric cancer was detected in 24patients（60.0%）,among which 13 were early cancer（54.2%）.[Conclusion]Regular follow-up and re-peated biopsy can effectively improve the detection rate of early gastric cancer in patients with GIEN,and especially in patients with LGIEN.As for patients with a biopsy showing HGIEN and a corresponding endoscopic feature,the final diagnosis is most likely to be gastric cancer,thus particular care should be taken to this patient group to avoid gastric cancer going unnoticed.