浙江省淳安县高危人群早期胃癌筛查情况分析

目的分析高危人群早期胃癌筛查情况,为临床预防与治疗提供有效依据.方法选择2016年5月至2017年5月确定符合胃癌筛查高危人群1274例,并通过胃镜和病理组织检查开展胃癌早期筛查.结果1274例高危人群做胃镜后,结果显示单纯慢性非萎缩性胃炎403例(31.63%),慢性非萎缩性胃炎伴糜烂229例(17.97%),慢性非萎缩性胃炎伴胆汁反流45例(3.53%),慢性非萎缩性胃炎同时伴糜烂及胆汁反流10例(0.78%),慢性萎缩性胃炎257例(20.17%),胃溃疡133例(10.44%),十二指肠球部溃疡27例(2.12%),复合性溃疡19例(1.49%),反流性食管炎75例(5.89%),胃窦炎35例(2.75%),胃息肉22例(1.73%),胃窦白斑5例(0.39%),食管溃疡5例(0.39%),胃窦毛细血管扩张3例(0.24%),食管静脉曲张6例(0.47%).其中755例患者取病理组织进行活检,结果显示炎性改变323例(42.78%),萎缩102例(13.51%),肠化16例(2.12%),萎缩伴肠化212例(28.08%),息肉样增生8例(1.06%),Barrett食管4例(0.53%),胃窦正常5例(0.66%),低级别上皮内肿瘤56例(7.42%),高级别上皮内肿瘤/原位癌8例(1.06%),浸润癌21例(2.78%).对21例浸润癌患者、8例高级别上皮内肿瘤/原位癌进行手术治疗或者内镜治疗,对其随访6个月未见复发,随访12个月发现3例复发(14.29%),做内镜或者手术处理.对56例低级别上皮内肿瘤患者随访6个月,13例(2.02%)进展为高级别上皮内肿瘤/原位癌,做内镜或手术处理12个月进行随访,未复发.对212例萎缩性胃炎伴肠上皮化生,随访12个月发现37例(17.45%)进展为低级别上皮内肿瘤,3例(1.42%)进展为高级别上皮内肿瘤/原位癌,做内镜或者手术处理.结论浙江省淳安县胃癌发病率较高,通过胃镜筛查能够有效发现早期胃癌、癌前疾病及其他病变,胃镜可作为一种常规筛查手段在该地区广泛开展,以达到胃癌的早发现、早诊断、早治疗.

Objective To observe and record the early gastric cancer screening in high-risk population in Chunan County of Zhejiang Province,so as to provide effective evidence for clinical prevention and treatment. Methods From May 2016 to May 2017,1274 local residents were selected to determine the high risk population for gastric cancer screening,and the screening of early cancer of gastric cancer was carried out by gastroscope and pathological examination. Results After gastroscopy in 1274 high-risk groups,the results showed that 403 cases of chronic non atrophic gastritis (31.63%),chronic non atrophic gastritis with erosion in 229 cases(17.97%),chronic non atrophic gastritis with bile reflux in 45 cases(3.53%), chronic non atrophic gastritis accompanied by erosion and bile reflux 10 cases(0.78%),chronic atrophy 257 cases of gastritis(20.17%),133 cases of gastric ulcer(10.44%),27 cases of duodenal ulcer(2.12%),19 cases of compound ulcers(1.49%),75 cases of reflux esophagitis(5.89%), 35 cases of gastric antrum lesions,22 cases of gastric polyps,gastric antral leukoplakia,gastric antrum hair,and gastric antrum hair. Microvascular dilatation occurred in 3 cases(0.24%)and esophageal varices in 6 cases(0.47%). Biopsy was performed in 755 patients. Pathological results showed that 323 cases(42.78%)were inflammatory changes,102 cases of atrophy(13.51%),16 intestinal metaplasia(2.12%),212 cases of atrophy with intestinal metaplasia(28.08%),8 polypoid hyperplasia(1.06%),Barrett diet 4(0.53%),sinus normal 5 cases,56 cases (7.42%) were low grade intraepithelial neoplasms,8 cases (1.06%) were high grade intraepithelial neoplasms/in situ neoplasms,and 21 cases (2.78%) were invasive neoplasms. 21 cases of invasive cancer,8 cases of high grade intraepithelial neoplasms/in situ neoplasms were treated with surgical treatment or endoscopic treatment. There was no recurrence after 6 months of follow-up. Three patients had recurrence(14.29%)after 12 months of follow-up and were treated endoscopically or surgically. Sixty-five patients with low-grade intraepithelial neoplasms were followed up for 6 months,and 13 patients(2.02%) progressed to high-grade intraepithelial neoplasms/surgical carcinoma. They were followed up for 12 months after endoscopic or surgical treatment and did not relapse. A total of 212 cases of atrophic gastritis with intestinal metaplasia,37 cases(17.45%)progressed to low-grade intraepithelial neoplasms, and 3 cases(1.42%)progressed to high-grade intraepithelial neoplasms/in situ neoplasms. Endoscopic or surgical treatment. Conclusion The incidence of gastric cancer in Chunan County of Zhejiang is high. Gastroscope screening can effectively detect early gastric cancer,precancerous disease and other diseases. Gastroscope can be widely carried out as a routine screening method in this area,in order to achieve early detection,early diagnosis and early treatment of gastric cancer.