胃底腺型胃癌内镜诊治三例并文献复习

Endoscopic treatment of gastric adenocarcinoma of the fundic gland:a report of three cases and a literature review

目的分析总结胃底腺型胃癌的临床特点、内镜下表现、病理及治疗,提高对该疾病的认识。方法回顾性分析北京医院2020年5月至2022年1月收治的3例胃底腺型胃癌患者的临床资料,其中2例因腹胀、腹痛症状就诊,1例因胃癌术后复查胃镜。结合白光胃镜和放大内镜、病理及免疫组化等结果,诊断胃底腺型胃癌。同时复习1990年1月至2021年4月报道的胃底腺型胃癌195例,分析并总结该疾病的内镜特点、病理特征和诊疗经验等。结果胃底腺型胃癌198例,男女比1.6∶1.0,年龄39~87岁,平均年龄65.3岁,79.82%(91/114)患者幽门螺杆菌阴性。胃镜检查结果显示平均直径8.97 mm,89.9%(178/198)患者病变浸润至黏膜下。91.98%(149/162)患者为主细胞优势型,98.86%(130/140)患者为无淋巴血管侵犯,97.6%(162/166)患者无复发、转移。结论胃底腺型胃癌为罕见的低异型高分化胃癌,发病机制尚不明确,老年人多发,与幽门螺杆菌感染无明显相关,主细胞优势型为主,内镜、病理及免疫组化有助于明确诊断,多数预后良好。

Objective To analyze and summarize the clinical characteristics,endoscopic manifestations,pathology and treatment of gastric adenocarcinoma of the fundic gland(GA-FD)to promote clinicians'understanding of this disease.Methods The clinical data of 3 patients with GA-FD admitted to Beijing Hospital from May 2020 to January 2022 were retrospectively analyzed.Among them,2 presented with abdominal distension or abdominal pain.The other case was diagnosed during follow-up endoscopy after gastrectomy for gastric cancer.A diagnosis of GA-FD was made based on the results of white light imaging,magnifying endoscopy,pathology and immunohistochemistry.In addition,we reviewed the literature about GA-FD between January 1990 and April 2021 from both national and international reports of 195 cases.We analyzed and summarized the endoscopic and pathological characteristics of the disease and insights on its diagnosis and treatment.Results Of all 198 cases,patients had a male/female ratio of 1.6/1.0 and an average age of 65.3 years(range:39-87 years).79.82%(91/114)of the patients were negative for Helicobacter pylori.Gastroscopy showed that the average diameter was 8.97 mm,and 89.9%(178/198)of the patients had lesions infiltrating into the submucosa.91.98%(149/162)of the patients had gastric chief cells as the predominant cell type,98.86%(130/140)had no lymphovascular invasion,and 97.6%(162/166)had no recurrence or metastasis.Conclusions GA-FD is a rare gastric cancer,with low-grade atypia and highly differentiated tissues.The mechanisms of GA-FD are not clear and the disease is more commonly seen in the elderly.There is no obvious correlation between Helicobacter pylori infections and GA-FD.Gastric chief cells make up the predominant cell type.The results of endoscopy,pathology and immunohistochemistry can help confirm the diagnosis.The prognosis of most cases is good.