幽门螺杆菌根除后早期胃癌的特点分析

CHARACTERISTICS OF EARLY GASTRIC CANCER AFTER HELICOBACTER PYLORI ERADICATION

目的探讨幽门螺杆菌(Hp)根除后早期胃癌的临床、内镜表现及组织病理学特点,提高诊断准确率。方法回顾性分析2017年1月—2021年12月诊治,经内镜黏膜下剥离术(ESD)切除的Hp根除后早期胃癌病人50例临床资料,分析其临床特征、内镜下表现及组织病理学特点。结果50例病人共54处病灶,有临床症状42例(84.0%),服用质子泵抑制剂(PPI)超过1年43例(86.0%)。胃黏膜中重度萎缩29例(58.0%),既往有肠上皮化生40例(80.0%)。54处病灶位于胃体或胃窦42处(77.8%),病灶平均直径≤20 mm有44处(81.5%);巴黎分型0-Ⅱc 29处(53.7%),0-Ⅱa+Ⅱc 17处(31.5%),0-Ⅱa 7处(13.0%),0-Ⅱb 1处(1.8%)。典型内镜下表现为地图样发红43处(79.6%)。26例病人追踪到免疫组化结果,Ki67阳性表达率≤50%有17例(65.4%)。结论Hp根除后早期胃癌的内镜特点表现为背景黏膜多有中重度萎缩、地图样发红、病灶直径≤20 mm、浅表凹陷型,据此可提高Hp根除后早期胃癌的诊断准确率。

Objective To investigate the clinical features,endoscopic findings,and histopathological features of early gastric cancer after Helicobacter pylori(Hp)eradication,and to improve diagnostic accuracy.Methods A retrospective analysis was performed for the clinical data of 50 patients with early gastric cancer after Hp eradication who underwent resection by endoscopic submucosal dissection(ESD)from January 2017 to December 2021,including clinical features,endoscopic findings,and histopathological features.Results The 50 patients had a total of 54 lesions,among whom 42(84.0%)had clinical symptoms and 43(86.0%)took proton pump inhibitors(PPI)for more than 1 year.Among these 50 patients,29(58.0%)had moderate to severe gastric mucosal atrophy,and 40(80.0%)had a past history of intestinal metaplasia.Among the 54 lesions,42(77.8%)were located in the gastric body or antrum and 44(81.5%)had a mean diameter of≤20 mm;based on the Paris classification,there were 29(53.7%)0-Ⅱc lesions,17(31.5%)0-Ⅱa+Ⅱc lesions,7(13.0%)0-Ⅱa lesions,and 1(1.8%)0-Ⅱb lesion.The typical endosco-pic finding was map-like redness in 43 lesions(79.6%).Immunohistochemical results were obtained for 26 patients,among whom 17(65.4%)had a positive Ki67 expression rate of≤50%.Conclusion Endoscopic features of early gastric cancer after Hp eradication include moderate to severe atrophy and map-like redness of the background mucosa,a lesion diameter of≤20 mm,and superficial depressed type,which can be used to improve the diagnostic accuracy of early gastric cancer after Hp eradication.