形似良性溃疡的早期胃癌的临床观察

Clinical observation of early gastric cancer resembling benign ulcer

目的分析形似良性溃疡的早期胃癌的临床病理特征以及胃镜检查技术在早期胃癌检查中的价值。方法回顾性分析2015年1月至2019年12月于安徽省宣城市中心医院就诊并确诊为早期胃癌,但内镜下形态改变类似良性溃疡的34例患者。结果 34例患者临床表现包括上腹部隐痛12例,反酸10例,食欲减退8例,嗳气4例。病理类型腺癌19例、低分化癌10例、印戒细胞癌5例,好发部位包括胃窦15例、胃体9例及胃角11例,均无淋巴转移和远处转移。胃镜检查显示为胃溃疡、糜烂性胃炎,有早癌可疑表现者26例,胃镜下取活检但病理报告非胃癌诊断者8例,漏诊率为23.5%,内镜检查首次活检阳性率为76.5%。结论形似良性溃疡的早期胃癌较容易漏诊,胃镜检查是对形似良性溃疡的胃早癌及癌前病变诊断的重要手段,但首次活检阳性率并不高,借助染色、内镜窄带成像(NBI)、放大等辅助技术以及临床随访复查可减少胃癌漏诊风险,同时内镜医师丰富的操作经验对于内镜下诊断十分有益。

Objective To explore the clinicopathological characteristics of early gastric cancer similar to benign ulcer and the value of gastroscopy in the examination of early gastric cancer.Methods A total of 34 patients with benign ulcer whose endoscopic morphological changes were similar to benign ulcers were analyzed retrospectively from January 2015 to December 2019 in Xuancheng Central Hospital of Anhui Province.Results The clinical manifestations of the 34 patients included 12 cases of upper abdominal pain,10 cases of acid reflux,8 cases of anorexia,and 4 cases of belching.There were 19 cases of adenocarcinoma,10 cases of poorly differentiated carcinoma and 5 cases of signet ring cell carcinoma.The most common sites included gastric antrum in 15 cases,gastric body in 9 cases and gastric angle in 11 cases,and there were no lymph metastasis or distant metastases.Gastroscopic examination showed gastric ulcer and erosive gastritis,26 cases had suspected early cancer phenotype,and 8 cases were not diagnosed with gastric cancer according to pathological report.The missed diagnosis rate was 23.5%,and the positive rate of the first biopsy was 76.5%.Conclusions Early gastric cancer similar to benign ulcer is easy to miss diagnosis.Gastroscopy is an important means for the diagnosis of early gastric cancer and precancerous lesions similar to benign ulcer,but the positive rate of the first biopsy is not high.Auxiliary techniques such as staining,narrow band imaging(NBI),magnification and clinical follow-up can reduce the risk of missed diagnosis of gastric cancer.At the same time,endoscopists’ rich experience is very useful for endoscopic diagnosis.