胃镜检查对早期胃癌的诊断价值分析

Analysis of the value of gastroscopy in the diagnosis of early gastric carcinoma

目的研究胃癌在胃镜下的形态及胃镜对胃癌的诊断价值,分析胃镜漏诊早期胃癌的影响因素。方法将首发确诊胃癌的561例患者和漏诊的39例患者(共600例),分别作为确诊组和漏诊组,确诊组中早期胃癌52例,作为早期胃癌组。比较确诊组和漏诊组患者首次胃镜检查时的镜下形态,早期胃癌患者胃镜检查漏诊的影响因素采用Logistics回归分析。结果确诊组胃癌患者镜下形态以溃疡、黏膜萎缩、出血和胃潴留为主,其中直径≥2 cm的溃疡、出血及胃潴留率高于漏诊组,差异均有统计学意义(P<0.05)。漏诊组患者镜下形态以充血水肿、点状糜烂、片状糜烂及溃疡直径<2 cm的溃疡为主,其中充血水肿、点状糜烂和片状糜烂率明显高于确诊组患者,差异均有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,年龄<60岁、需要倒镜观察、无报警症状和病理分型为Ⅱb型是胃镜检查漏诊早期胃癌的独立危险因素。结论胃镜对早期胃癌的诊断价值较高,但对于年龄<60岁、需倒镜观察、无报警症状和病理分型为Ⅱb型病灶应仔细观察,尽可能避免漏诊。

Objective To investigate the pathological morphology of gastric carcinoma under gastroscope and to analyze the factors influencing the missed diagnosis of early gastric carcinoma by gastroscopy. Method The study enrolled 600 cases of gastric carcinoma, including 561 patients who were diagnosed as gastric carcinoma at first examination and 39 patients that had missed diagnosis, and these patients were assigned as diagnosis group and missed diagnosis group, respectively, furthermore, a subgroup of 52 cases of early gastric carcinoma was identified in diagnosis group, as early gastric cancer group. The pathological morphology under gastroscope were compared between diagnosis group and missed diagnosis group, besides, the factors influencing the missed diagnosis of early cancer were investigated by Logistic regression analysis. Result The primary pathological morphology of diagnosis group included ulcer, mucosal atrophy, hemorrhage and gastric retention, among these symptoms, there were more patients with ulcer diameter ≥2 cm, hemorrhage and gastric retention in diagnosis group compared with missed diagnosis group, and the differences were of statistical significance (P<0.05). In missed diagnosis group, patients were mainly observed with congestion and edema, punctate erosion, patchy erosion and ulcer <2 cm, and the patients with congestion and edema, punctate and patchy erosion were significantly higher in missed diagnosis group than that in diagnosis group (P<0.01). Multivariate Logistic regression analysis showed that, age <60 years old, requiring examination during the withdrawal of gastroscope, no alert symptoms, and pathological subtype of IIb were independent risk factors for missed diagnosis of early gastric cancer. Conclusion Gastroscopy is diagnostically valuable in identifying gastric cancer, but cautious observation is indispensable for patients aged <60, requiring examination during withdrawal of gastroscope, no alert symptom and with pathological subtype IIb lesions, in order to avoid missed diagnosis as far as possible.