胃癌前粘膜变化的自然演变规律研究

目的 研究胃癌前胃粘膜变化发展演变的规律，以及胃镜随访检查对胃癌早期发现的意义。方法 对1417例患者进行胃镜检查，其中750例进行胃镜随访检查。结果 1417例中首次胃镜检查即诊断为胃癌患者64例，检出率4．5％；在以后随访检查中又先后发现胃癌82例。癌前变化人群95％癌变所需时间：萎缩性胃炎11．6年，肠上皮化生11．4年，异型增生5．7年，肠上皮化生(中、重度) 异型增生(中、重度)4．5年。胃癌中有许多(54．9％)并不经历肠上皮化生或异型增生阶段。结论 对胃粘膜异型增生和肠上皮化生等病变患者的胃镜检查随访有利于提高胃癌(尤其是早期胃癌)的检出率；有必要更新癌前变化的概念，探索研究新的尚未认识的癌前病变，并提出新的判断指标。

Study on natural history of premalignant gastric lesions

Objective To study the evolution of premalignant gastric lesions and the significance of follow up by gastroscopy for gastric cancer.Methods Among 1 417 cases undergoing gastroscopy examination,750 cases were followed up.Results 64 cases of gastric cancer in 1 417 cases were confirmed by initial gastroscopy examination(4.5%),and then 82 cases of gastric cancer were detected during follow up.The time of canceration was 11.6 years for atrophic gastritis and 11.4 years for intestinal metaplasia,5.7 years for hyperplasia and 4.5 years for intestinal metaplasia(moderate and severe)+hyperplasia(moderate and severe).Many gastric cancer did not go through intestinal metaplasia or hyperplasia(54.9%).Conclusion The examination and follow up of the patients with intestinal metaplasia or hyperplasia is helpful for the detection of gastric cancer,particular early-stage gastric cancer.It is necessary to redefine the concept of premalignance of cancer in order to explore the unknown premaligance of cancer and raise new judgment index.