浅表扩散型早期胃癌的内镜及临床特点分析

目的探讨浅表扩散型早期胃癌的内镜下形态表现及病理特征。方法收集4年间经手术病理证实的早期胃癌患者466例,其中病灶最长径≥5 cm的浅表扩散型早期胃癌患者26例,回顾性分析其临床资料、内镜下形态、手术记录及术后病理结果,并与普通型早期胃癌进行比较。结果 466例早期胃癌患者中,有26例患者为浅表扩散型,占早期胃癌患者的5.58%。其临床表现以中上腹疼痛居多(80.77%,21/26),内镜下检查病灶累及一个以上胃区者15例(57.69%),镜下形态主要为溃疡增殖型(46.15%,12/26)。手术切除胃癌标本中浅表凹陷型占38.46%,而病理上低分化型及未分化型占61.54%;胃癌灶黏膜下层浸润率及淋巴结转移率都较普通型EGC高(65.38%vs 39.77%,P<0.01;38.46%vs 12.27%,P<0.01)。结论浅表扩散型早期胃癌病灶范围广,边界不易判断;黏膜下层浸润率及淋巴结转移率较高,因此应强调术前癌灶范围的正确界定、手术中病灶的完整切除及区域淋巴结的扩大清扫。

Analysis of endoscopic and clinicopathological features of superficial spreading type of early gastric cancer

Objective To analyze the endoscopic and clinicopathologic features of superficial spreading type of early gastric cancer.Methods 466 patients confirmed early gastric cancer by pathology were collected during 4 years,out of which 26 cases were superficial spreading type with the longest diameter greater than 5 cm.The medical history,endoscopic images,surgical records and pathologic results were reviewed.A comparison was done between superficial spreading type and common type of early gastric cancer.Results The superficial spreading type accounted for 5.58% of all early gastric cancer.The major symptom was epigastric pain(80.77%,21/26).At endoscopy,the lesions mainly involved more than one gastric region(57.69%) and the ulcerative type was the most frequent presentation(46.15%).10 cases(38.46%) of superficial depressed type of early gastric cancer were observed.The occurrence of poor differentiated lesions was 61.54%.The distinguishing histopathological features were compared with the common type of early gastric cancer,submucosal invasion and lymph node metastasis(65.38% vs 39.77%,P<0.01;38.46% vs 12.27%,P<0.01).Conclusion The superficial spreading type of early gastric cancer is characterized by the wide and superficial spreading activity of the cancer with obscure boundary,which also has a higher incidence of submucosal invasion and lymph node metastasis.Therefore,the accurate localization before the surgery,the complete resection and sufficient lymph node dissection during the surgery should be emphasized.