胃镜诊断早期胃癌的临床体会

本文通过探讨早期胃癌的临床特点及胃镜在诊治中的应用,运用经直视+活检在其边缘部位常规多方向活检,发现内镜检查对早期胃癌有很大临床诊断价值.既可直接观察胃粘膜微细变化,又可借助活检进行组织学及细胞学检查,提高早期胃癌的诊断率.     

醋酸-靛胭脂染色在基层医院早期胃癌及癌前病变诊断中的应用

目的探讨提高基层医院早期胃癌及癌前病变检出率的方法。方法经胃镜检查发现胃黏膜异常进行醋酸-靛胭脂染色后取活检病理检查患者72例为染色组,同期胃镜下发现黏膜异常患者直接取组织活检病理检查患者68例为对照组,观察胃黏膜染色情况并与病理检查结果对比分析,比较2组患者早期胃癌及癌前病变的检出率。结果醋酸-靛胭脂染色后胃黏膜表现为黏膜褪色(16.7%)、着色不良(63.9%)及着色均匀(14.3%)。其中染色组黏膜褪色患者中早期胃癌或高级别上皮内瘤变的检出率(91.7%)显著高于着色不良(8.6%)和着色均匀(0.0%);黏膜着色不良中低级别上皮内瘤变或肠上皮化生比例(82.6%)显著高于黏膜褪色(8.3%)和着色均匀(14.3%)。染色组早期胃癌及癌前病变检出率(13.9%,63.9%)均分别显著高于对照组(2.9%,29.4%)。结论胃镜下醋酸-靛胭脂染色能够提高基层医院早期胃癌及癌前病变的检出率,并且成本低廉,操作简便,适宜于基层医院推广应用。     

早期胃癌60例的临床病理特点分析

目的探讨早期胃癌的临床与病理特点,为及早诊疗提供依据。方法选择60例早期胃癌患者,进行统计分析其临床与病理特点。结果发病高峰在50～70岁,男性多见。大部分有胃痛史,大体分型以凹陷型为主,病理分类中以管状腺癌为主。结论早期胃癌好发于中老年人,临床特征与一般胃病相似．关键在于提高早期检出率,早期治疗。     

原发性胃恶性淋巴瘤14例胃镜表现及临床分析

目的:探讨原发性胃恶性淋巴瘤的胃镜下表现及临床诊断和治疗. 方法:回顾性分析1995年至2009年14例原发性胃恶性淋巴瘤患者的临床资料及胃镜下表现. 结果:胃恶性淋巴瘤男5例,女9例,平均年龄54岁,胃镜下表现肿块型2例,溃疡型7例,浸润型2例,结节型3例.霍奇金病1例,非霍奇金病13例,其中12例为B细胞来源,1例为T细胞来源.手术治疗患者中2例术后1年内死亡,2年及以上生存者6例(54.5%),5年及以上生存者3例(27.3%).2例胃黏膜相关淋巴组织淋巴瘤,给以抗幽门螺杆菌联合化学治疗. 结论:原发性胃恶性淋巴瘤诊断困难,可采取普通胃镜联合病理检查等多种诊断手段综合诊断,治疗还需进一步随访观察.     

内镜下粘膜切除术治疗早期胃癌36例护理

早期胃癌（early gastric cancer,EGC）是指胃癌病变位于粘膜或粘膜下层,而无论病灶大小和是否有淋巴结转移。内镜下粘膜切除术（endoscopic mucosal resection,EMR）是应用辅助技术在内镜下对消化道较小的无蒂浅表性恶性病变行病灶切除的方法。随着内镜技术和器械的改进与发明,EMR技术得到不断改进与创新,已成为治疗早期胃癌的重要手段     

128例内镜黏膜下剥离术治疗早期胃癌的护理

<正>胃癌是常见的恶性肿瘤之一,早期胃癌是指病灶不超过黏膜下层而无论有无转移的胃癌。早期胃癌的早期诊断和治疗大大提高了胃癌患者的预后[1]。随着消化内镜诊断和治疗技术的不断发展,内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)使早期胃癌病灶切除范围更加扩大,并且安全可靠,是内镜下黏膜切除术(EMR)的补充和演进,目前已成为消化道早癌及其它肿瘤的内镜下切除的新技术[2]。为了探讨ESD治疗早期胃癌的最佳护理措施,现将我院128例经ESD治疗的早     

378例早期胃癌病理特征分析

目的：研究378例早期胃癌(early gastric cancer,EGC)的病理特征及临床意义。方法：回顾分析2012年8月至2014年8月河北医科大学第四医院378例EGC标本的肿瘤直径、浸润深度、肉眼分型、组织学分型、淋巴结转移进行检查。结果：全组病例男性312例,女性66例;182例肿瘤局限在粘膜层,196例侵及粘膜下层;发生部位主要位于贲门222例(58.73%);肉眼分型以Ⅱ型为主(53.44%);组织学类型以管状腺癌为主(77.25%);出现淋巴结转移20例(5.29%)。结论：浸润深度、组织学类型、淋巴结转移等是EGC组织病理学诊断的重要指标。     

7033例纤维胃镜活检的病理分析

我们从1977～1987年10年间进行纤维胃镜粘膜活检7033例,其中正常粘膜288例,占4.09%;浅表性胃炎4487例,占63.79%;萎缩性胃炎357例,占5.07%;肥厚性胃炎3例(0.04%),各部位息肉56例(0.79%);慢性溃疡232例(3.29%);肿瘤1091例(15.55%),其中胃癌780例,占11.09%;食管癌302例,占4.29%;其他慢性炎症519例(7.37%)。正常粘膜检出率偏高萎缩性胃炎检出率偏低。浅表性胃炎最终可发展为萎缩性胃炎,而萎缩性胃炎部分可引起肠型胃癌的发生,三者之间的病变有一定的关系。提高纤维胃镜的活检诊断水平必须从取材、制片、阅片等每个环节做起,病理诊断必须结合纤维胃镜肉眼所见及临床资料。     

消化性溃疡105例胃镜及临床分析

目的分析消化性溃疡胃镜检查确诊情况;资料:我院5年来接受胃镜检查者420例中确诊的105例消化性溃疡病患者;方法统计分析方法,将消化性溃疡检出率与性别、年龄、溃疡部位和发病季节等进行统计分析及比较;结果 PU的检出率,PU与性别、年龄的关系,检出部位分布,大小及形状,分期以及幽门螺旋杆菌感染等统计结果;结论消化性溃疡与季节关系,消化性溃疡与年代变化有一定的关系等问题.     

56例儿童消化性溃疡的临床诊治分析

目的探讨儿童消化性溃疡的临床特征,呼吁重视儿童消化性溃疡的早期诊断和治疗。方法回顾性总结2006年8月～2007年8月间确诊的儿童消化性溃疡56例,分析其临床特征、诊断、治疗。结果56例儿童消化性溃疡中内镜下发现50例,手术发现消化性溃疡6例。十二指肠溃疡36例,胃溃疡15例,复合性溃疡5例;HP阳性43例,占76.8%,遗传因素19例,心理因素11例,不良饮食习惯34例,临床特征为反复发作的腹疼、黑便、呕血、反复呕吐、贫血等;采用克拉霉素＋阿莫西林或甲硝唑＋奥美拉唑三联疗法为主的综合治疗,溃疡面愈合良好。结论儿童消化性溃疡并不少见,胃镜检出率高,应及时行胃镜检查确诊。儿童消化性溃疡病致病因素具有多样性,临床表现多不典型。新三联疗法治疗消化性溃疡效果好。儿童消化性溃疡是消化道穿孔的常见原因,应及时诊断和治疗。     

Surgical outcome of synchronous second primary cancer in patients with gastric cancer

PURPOSE: In order to improve the likelihood of curative and safe gastric surgery, this study investigated the clinical features and surgical outcomes of gastric cancer with a synchronous cancer. PATIENTS AND METHODS: The clinicopathological data of 10,090 gastric cancer patients at Samsung Medical Center from September 1994 to December 2006 were retrospectively analyzed. Of them, 90 patients with gastric cancer and a synchronous second primary cancer underwent simultaneous surgery for gastric cancer and second primary cancer. The clinicopathological characteristics of the patients, surgical outcome, and prognosis were examined. RESULTS: The most common synchronous second primary cancer was colorectal cancer (37 patients), followed by hepatocellular carcinoma (13 patients), renal cell carcinoma (11 patients), and pancreatic carcinoma (5 patients). The incidence of a second primary cancer in the gastric cancer patients was higher than the incidence in the general population. Stage I gastric cancer patients had more synchronous cancers than stage II patients (59 vs. 31). Postoperative complications were encountered in 7 patients. Four patients underwent reoperation. Two patients died from hepatic failure and leakage of esophagojejunal anastomosis. The 5-year survival rate of stage I and II gastric cancer was 61% and 39%, respectively. CONCLUSION: Since gastric cancer patients with a synchronous second primary cancer are not rare, the possibility of synchronous cancers in gastric cancer patients should be considered. The prognosis of early stage gastric cancer patients with a synchronous second primary cancer was influenced more by the presence of the second primary cancer than by the gastric cancer itself.     

Retrospective studies of early gastric cancer in a high incidence area of Italy

Frequency and characteristics of early gastric cancer (egc) were evaluated in a retrospective study of 511 surgical specimens of gastric carcinoma. We observed a total of 46 egc in 40 patients. The predominant macroscopic type was IIc, followed by I and III. On the basis of histological appearance, 25 egc were of intestinal type and 15 of diffuse type. Seventy-six per cent of egc were localized at the lesser curvature of the stomach and in particular at the pyloric antrum. Twenty-two egc were limited to the mucosal layer. No relationship was observed between macroscopic type or histological characters, and tumour staging. As Italy can be considered a high-risk country for gastric carcinoma and because this disease is in many respects similar to that observed in Japan, it seems possible to obtain a reduction of the death rate for gastric cancer by increasing, as in Japan, the number of cancers diagnosed in the early phase.     

早期胃癌临床诊治的若干问题

胃癌是全球范围内死亡率最高的恶性肿瘤之一,而胃癌的早期发现和规范化治疗是改善胃癌患者的重要手段。随着医疗技术的发展,早期胃癌的检出率逐年提高,并且手术方式逐渐从传统开腹根治术向内镜切除和腹腔镜手术过渡。本课题组通过多年系列研究,联合国内外最新发现对早期胃癌临床生物学特征、分期系统评估和综合治疗方案等方面进行深入研究,为指导早期胃癌临床诊治提供科学依据。     

Dissecting expression profiles of gastric precancerous lesions and early gastric cancer to explore crucial molecules in intestinal-type gastric cancer tumorigenesis

Intestinal-type gastric cancer (IGC) has a clear and multistep histological evolution. No studies have comprehensively explored gastric tumorigenesis from inflammation through low-grade intraepithelial neoplasia (LGIN) and high-grade intraepithelial neoplasia (HGIN) to early gastric cancer (EGC). We sought to investigate the characteristics participating in IGC tumorigenesis and identify related prognostic information within the process. RNA expression profiles of 94 gastroscopic biopsies from 47 patients, including gastric precancerous lesions (GPL: LGIN and HGIN), EGC, and paired controls, were detected by Agilent Microarray. During IGC tumorigenesis from LGIN through HGIN to EGC, the number of activity-changed tumor hallmarks increased. LGIN and HGIN had similar expression profiles when compared to EGC. We observed an increase in the stemness of gastric epithelial cells in LGIN, HGIN, and EGC, and we found 27 consistent genes that might contribute to dedifferentiation, including five driver genes. Remarkably, we perceived that the immune microenvironment was more active in EGC than in GPL, especially in the infiltration of lymphocytes and macrophages. We identified a five-gene signature from the gastric tumorigenesis process that could independently predict the overall survival and disease-free survival of GC patients (log-rank test: p < 0.0001), and the robustness was verified in an independent cohort (n > 300) and by comparing with two established prognostic signatures in GC. In conclusion, during IGC tumorigenesis, cancer-like changes occur in LGIN and accumulate in HGIN and EGC. The immune microenvironment is more active in EGC than in LGIN and HGIN. The identified signature from the tumorigenesis process has robust prognostic significance for GC patients. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.     

Histologic heterogeneity and mucin phenotypic expression in early gastric cancer

Although the major histologic type in small gastric cancers, less than 10 mm in diameter, is differentiated-type adenocarcinoma (D.Ca), the incidence of D.Ca and that of undifferentiated-type adenocarcinoma (UD.Ca) is almost the same in all early gastric cancers. Histologic conversion from D.Ca to UD.Ca has been speculated, however, a detailed examination of this phenomenon has not yet been performed. Three-hundred and 51 early gastric cancers (D.Ca, 150 (42.7%) lesions; UD.Ca, 93 (26.4%) lesions; and mixed differentiated and undifferentiated type (D&UD.Ca), 108 (30.8%) lesions; tumor size less than 10 mm in diameter; 64 lesions, more than 10 mm, 287 lesions) were examined histochemically with paradoxical concanavalin A type III and high-iron diamine-Alcian blue (pH 2.5), and immunohistochemically with antigastric mucin antibody. The associations between tumor size, tumor differentiation and phenotypic expression of mucin were examined. Regardless of the tumor size, mucin phenotypic expression in the mucosal lesions examined was preserved. Of 47 cancers with a gastrointestinal mucin phenotype (GIM type) or a gastric mucin phenotype (GM type) measuring less than 10 mm, 35 (74.5%) consisted of D.Ca and 12 (25.5%) of both D&UD.Ca and UD.Ca, while of 224 GIM or GM type cancers measuring more than 10 mm, 64 (28.6%) consisted of D.Ca and 160 (71.4%) of both D&UD.Ca and UD.Ca. Differences between these two groups were statistically significant (P < 0.001). Of 15 cancers with an intestinal mucin phenotype (IM type) measuring less than 10 mm, 12 (80.0%) consisted of D.Ca and three (20.0%) of both D&UD.Ca and UD.Ca, and of 50 IM type cancers measuring more than 10 mm, 35 (70.0%) consisted of D.Ca and 15 (30.0%) of both D&UD.Ca and UD.Ca. Differences between these two groups were not statistically significant. These findings suggest that small D.Ca showing gastric mucin expression may transform into UD.Ca during the progression of early gastric cancer.     

Predicting lymph node status in patients with early gastric carcinoma using double contrast-enhanced ultrasonography

Introduction

Double contrast-enhanced ultrasonography (DCUS) is a new method we used in predicting lymph node metastasis (LNM) in patients with early gastric cancer.

Material and methods

Seventy-six patients with early gastric cancer diagnosed by gastroscope and confirmed by pathology after operation were examined using DCUS preoperatively. Group N1 included 15 patients with LNM and group N0 61 patients without LNM.

Results

In group N1, 13 patients (87%) had marked hyperenhancement during early arterial phase using DCUS, and 2 patients (13%) were unmarked as hyperenhancement. In group N0, 24 patients (39%) had marked hyperenhancement during early arterial phase using DCUS, and 37 patients (61%) had unmarked hyperenhancement. The sensitivity and specificity of marked hyperenhancement in predicting LNM in patients with early gastric cancer was 86.7% and 60.7% respectively, and the Youden’s index was 0.474. The κ value of this method was 0.89.

Conclusions

Double contrast-enhanced ultrasonography is a new valuable method to evaluate LNM at an early stage of gastric cancer and prognosis of early gastric cancer preoperatively.     

原发性胃癌中19p部分微卫星多态位点杂合性缺失分析

目的 筛选胃癌19p部分微卫星多态位点的杂合性缺失（loss of heterozygosite,LOH)频率,以初步确定19p上与胃癌相关基因连锁最密切的微卫星多态位点。方法 采用聚合酶链反应-单链长度多态（polymerase chain reaction-single strand length polymorophism,PCR-SSLP)-银染法选取19p上9对微卫星多态标记（D19S424,D19S216,D19S406,D19S413。D19S221,D19S226,D19S411,D19S883,D19S886）,对43例原发性胃癌的杂合性缺失情况进行了分析。结果 43例中22例至少在1个位点发生LOH,总缺失率为48.88%,这9个位点的LOH频率分别为29.63%,11.53%,33.33%,8.57%,13.15%,8.00%,6.45%,6.89%,10.71%,在D19S886也同时出现微卫星不稳定性（microsatellite instability,MSI)17.85%。结论 提示19p上的LOH缺失频发区域可能涉及与人类原发性胃癌发生发展相关基因的存在。     

快速康复外科及早期肠内营养在胃癌术后患者治疗中的临床价值研究

目的:观察运用快速康复外科理论(fast track surgery,FTS)及早期肠内营养(early enteral nutrition, EEN)对胃癌术后患者临床指标及免疫功能作用,探讨其促进患者康复的机制及临床价值.方法:回顾性分析2010年2月~2014年1月我院普外科收治的197例胃癌手术患者资料,其中2012年 6月~2014年1月连续收治的92例采用快速康复外科治疗及早期肠内营养支持(FTS组);2010年 2月~2012年6月连续收治的105例患者按照传统围手术期及常规营养方式处理(传统组),两组行非随机对照研究,比较两组患者术后首次排气、排便时间,住院时间,各组患者手术前1 d,后第 8天免疫球蛋白(IgA、IgG、IgM),淋巴细胞计数(LYM)和细胞因子CD4+、CD8+、CD4+/CD8+值及术后并发症的情况.结果:FTS组同传统组相比,患者术后首次排气时间(2.2 vs. 4.9 d)、首次排便时间(3.4 vs. 5.8 d)明显提前,住院时间(5.2 vs. 8.9 d)显著缩短,差异均具有统计学意义(P<0.05).FTS组患者IgA、IgM、CD4+显著升高,LYM和CD4+/CD8+升高,IgG接近术前水平,CD8+降低;FTS组患者并发症低于传统组,但无统计学差异(P=0.45).结论:应用快速康复外科理念及早期肠内营养处理可促进术后肠功能的恢复,提高胃癌术后患者免疫功能,但并不增加术后并发症发生率.