超声内镜对浅表胃癌诊断及治疗决策的影响

目的探讨术前EUS在浅表胃癌诊断及治疗决策中的价值。方法2006年1月至2014年12月期间，于北京协和医院行胃镜检查及病理活检确诊为浅表胃癌，并接受病灶切除及术前EUS检查的患者共77例（83处病灶，其中早期胃癌72处、进展期胃癌11处）纳入回顾性研究，以ESD或外科手术后病理为金标准，采用敏感度、特异度和准确率等指标评估术前EUS对浅表胃癌浸润深度的判断价值，并运用多因素Logistic回归对影响判断准确性的因素进行分析。结果EUS判断早期胃癌的敏感度、特异度和准确率分别为91.7%（66/72）、81.8%（9/11）和90.4%（75/83）；对于早期胃癌，EUS鉴别黏膜内癌与黏膜下癌的准确率为66.7%（48/72），阳性预测值达91.3%（42/46）。多因素Logistic回归分析发现，合并溃疡（OR＝7.513, 95%CI：1.735-32.541，P〈0.05）和病理类型为未分化型癌（OR＝8.194，95%CI：1.602-41.903，P〈0.05）是影响EUS判断浅表胃癌浸润深度准确性的独立危险因素。结论EUS对于判断浅表胃癌是否为早期胃癌的准确性较高。其中，EUS判断浸润深度局限于黏膜层的可以考虑内镜下治疗；但对于EUS判断病变浸润至黏膜下层的患者，需要结合内镜下表现综合考虑。

胃双重造影诊断浅表型(Ⅱ型)早期胃癌

本文分析经手术病理证实的浅表型(Ⅱ型)早期胃癌39例。其中Ⅱ_a型7例,Ⅱ_b型5例,Ⅱ_c型23例,Ⅱ_e+Ⅱ_c型4例。主要X线表现为①浅表隆起,表面凹凸不平,边缘分叶状;②多个大小不等结节状隆起呈簇状聚集,形态固定;③浅表糜烂呈淡薄钡湖影,形态不规则,底部不平整;④胃小区破坏,胃小沟中断,局部结构异常紊乱;⑤病变区邻近胃壁僵硬,伸展受限,轮廓线毛糙;⑥粘膜皱襞不规则纠集,尖端突然变细,中断或杵状增粗。对各亚型早期胃癌的X线鉴别诊断及X线检查方法进行了讨论。认为掌握正确的胃双重造影技术,并与粘膜法、充盈法和加压法联合应用,同时重视透视下跟踪观察钡剂流动,发现异常及时摄点片的方法,才可能获得优质的双对比造影片,清晰显示病变细微变化,提高该型早期胃癌的诊断水平。

重视浅表扩散型早期胃癌的识别和治疗

浅表扩散型早期胃癌又称平坦弥漫型早期胃癌,是早期胃癌的一种特殊类型。随着早期胃癌诊断与治疗研究的深入,此类早期胃癌的漏诊和误判应该引起临床工作者的高度重视。其临床症状缺乏特异性。内镜下形态多变,病变黏膜常呈粗糙、颗粒、细结节或糜烂及浅表溃疡等,有时边界难以确定。病灶最大直径超过4 cm。淋巴结转移率明显高于普通早期胃癌。努力确定病变范围和边界是提高此类早期胃癌治疗疗效的关键。

数字X线机应用于早期浅表型胃癌的诊断观察

目的分析数字X线机应用于早期浅表型胃癌的应用价值。方法抽取2013年5月-2015年10月在医院接受数字X线机检查的78例早期浅表型胃癌患者作为研究对象,随机分为对照组和观察组各39例,对照组采用普通X线进行检查,观察组采用数字X线进行检查,对比2组患者的诊断率。结果观察组的39例患者中有37例确诊为早期浅表型胃癌,对照组的39例患者中有31例确诊为早期浅表型胃癌,观察组患者的诊断率明显较对照组高,差异具有统计学意义(P<0.05)。结论数字X线机检查是诊断早期浅表型胃癌的基本手段,掌握娴熟的胃双重造影技术,并配合黏膜法、加压法和充盈法,跟踪观察钡剂流动,获得优质造影片,显示清晰的病变细微变化,可以准确了解胃部癌组织情况,有利于早期胃癌的诊断,对早期浅表型胃癌的诊断有重要意义。

术前超声内镜诊断浅表性胃癌准确性的影响因素研究

目的探讨术前超声内镜在浅表性胃癌中的诊断价值及影响因素。方法回顾性分析三家医院2014年1月至2018年1月收治的130例浅表性胃癌患者的临床资料,所有患者术前接受超声内镜检查,并经手术病理诊断证实为浅表性胃癌。以病理诊断结果为金标准,根据超声内镜与病理诊断的吻合情况,分成吻合组、非吻合组。比较两组临床病理特征,包括性别、年龄、肿瘤部位、组织学分型、肿瘤直径、肿瘤大体分型、肿瘤侵袭深度、病理分期,采用logistics回归分析明确影响超声内镜诊断准确性的独立危险因素。结果在130例患者中,有102例与手术病理检查结果吻合,占78.46%,有28例不吻合,占21.54%。非吻合组肿瘤位于胃底部占比为35. 71%,肿瘤直径<3cm占比为78. 57%,均高于吻合组的17. 65%、49. 02%,两组比较差异均有统计学意义(P <0.05)。Logistics回归分析提示肿瘤部位(胃底部)、肿瘤直径(<3 cm)是超声内镜诊断浅表性胃癌准确性的独立危险影响因素(P <0. 05)。结论超声内镜在浅表性胃癌患者术前诊断中具有一定价值,其独立影响因素包括肿瘤部位与肿瘤直径。

浅表扩散型早期胃癌1例

病例：患者女，79岁，因“腹胀2年、伴中上腹隐痛6个月”于2011年5月6日入院。患者2年前进食后出现上腹部胀痛，可自行好转，故未予重视。6个月前无明显诱因下出现中上腹持续性隐痛，进食后明显加重，伴恶心呕吐，呕吐物为胃内容物，偶有便秘，无反酸嗳气，无呕血黑便。

CT动态增强粘膜线中断对早期浅表型胃癌的诊断价值

目的:评价CT动态增强扫描粘膜线中断对早期浅表型胃癌的诊断价值,提高早期胃癌的诊断率。方法:回顾性分析本院2020年1月至2020年6月期间由病理证实患者25例,由两位高年资主治医师通过CT动态增强扫描粘膜线情况来评估胃良恶性病变,连续性存在者判断为良性病变,连续性中断者判断为早期胃癌,两位医生协商后取得一致的诊断结果。结果:25例由病理证实的病例中10例为良性病变,15例为早期胃癌,两位阅片者诊断结果与病理相符率较高。结论:CT动态增强扫描粘膜线中断对早期浅表型胃癌的诊断具有较高的价值。

重视几类难辨性胃癌的识别和检漏

胃癌是中国最常见的恶性肿瘤,但临床上包括进展期胃癌在内的误判和漏诊情况严重,特别是浅表扩散型早期胃癌、弥漫浸润型胃癌(皮革胃)和形似胃炎样胃癌。本文介绍这几种胃癌的特点及提高诊断正确性的方法和经验。

Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer

AIM: To evaluate the histological features of gastric mucosa, including Helicobacter pylori infection in patients with early gastric cancer and endoscopically found superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer. METHODS: The biopsy specimens were taken from the antrum, corpus and upper angulus of all the patients. Giemsa staining, improved toluidine-blue staining, and Hpylori-specific antibody immune staining were performed as appropriate for the histological diagnosis of H pylori infection. Hematoxylin-eosin staining was used for the histological diagnosis of gastric mucosa inflammation, gastric glandular atrophy and intestinal metaplasia and scored into four grades according to the Updated Sydney System. RESULTS: The overall prevalence of H pylori infection in superficial gastritis was 28.7%, in erosive gastritis 57.7%, in gastric erosion 63.3%, in gastric ulcer 80.8%, in early gastric cancer 52.4%. There was significant difference (P<0.05), except for the difference between early gastric cancer and erosive gastritis. H pylori infection rate in antrum, corpus, angulus of patients with superficial gastritis was 25.9%, 26.2%, 25.2%, respectively; in patients with erosive gastritis 46.9%, 53.5%, 49.0%, respectively; in patients with gastric erosion 52.4%, 61.5%, 52.4%, respectively; in patients with gastric ulcer 52.4%, 61.5%, 52.4%, respectively; in patients with early gastric cancer 35.0%, 50.7%, 34.6%, respectively. No significant difference was found among the different site biopsies in superficial gastritis, but in the other diseases the detected rates were higher in corpus biopsy (P<0.05). The grades of mononuclear cell infiltration and polymorphonuclear cell infiltration, in early gastric cancer patients, were significantly higher than that in superficial gastritis patients, lower than that in gastric erosion and gastric ulcer patients (P<0.01); however, there was no significant difference compared with erosive gastritis. The grades of mucosa glandular atrophy and intestinal metaplasia were significantly highest in early gastric cancer, lower in gastric ulcer, the next were erosive gastritis, gastric erosion, the lowest in superficial gastritis (P<0.01). Furthermore, 53.3% and 51.4% showed glandular atrophy and intestinal metaplasia in angular biopsy specimens, respectively; but only 40.3% and 39.9% were identified in antral biopsy, and 14.1% and 13.6% in corpus biopsy; therefore, the angulus was more reliable for the diagnosis of glandular atrophy and intestinal metaplasia compared with antrum and corpus (P<0.01). The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H pyloripositivity was 50.7%, 34.1%; of erosive gastritis 76.1%, 63.0%; of gastric erosion 84.8%, 87.8%; of gastric ulcer 80.6%, 90.9%; and of early gastric cancer 85.5%, 85.3%, respectively. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H pylorinegativity was 9.9%, 6.9%; of erosive gastritis 42.5%, 42.1%; of gastric erosion 51.1%, 61.9%; of gastric ulcer 29.8%, 25.5%; and of early gastric cancer 84.0%, 86.0%, respectively. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis, erosive gastritis, gastric erosion, and gastric ulcer patients with H pylon positivity was significantly higher than those with H pylori negativity (P<0.01); however, there was no significant difference in patients with early gastric cancer with or without H pylori infection. CONCLUSION: The progression of the gastric pre-cancerous lesions, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis and gastric ulcer was strongly related to H pylori infection. In depth studies are needed to evaluate whether eradication of H pylori infection will really diminish the risk of gastric cancer.