250例早期胃癌临床病理分析

目的探讨进一步提高早期胃癌诊断水平的因素。方法对2005—2008年间应用上皮内瘤变（IN）的概念诊断的250例早期胃癌患者的病理资料进行分析。结果本组患者术前内镜活检诊断可疑癌15例，高级别上皮内瘤变（HGIN）90例．胃癌145例。术后病理诊断浸润型早期胃癌224例，其中Ⅰ型5例（2．2％），均为黏膜下癌（Tsm）患者；Ⅱ型190例（84．8％），有82例为黏膜内癌（Tm），108例为Tsm；Ⅲ型29例，5例Tm，24例Tsm。未浸润性病变（Tis）26例。以高分化为主要组织学类型者184例（73．6％），其中26例Tis，58例Tm．100例Tsm。有淋巴结转移者21例．其中Tm组2例（2．3％），均发生在低分化组：Tsm组19例（13．9％）：Ⅱ型病例淋巴结转移15例（7．9％），Ⅲ型病例6例（20．7％）。90例术前内镜活检诊断为HGIN的患者，术后病理检查24例为Tis，29例为Tm。37例为Tsm。结论高分化病变是早期胃癌的主要组织学类型。IN诊断概念的应用可能提高早期胃癌检出率。

Clinicopathological analysis of 250 patients with early-stage gastric cancer

Objective To explore the factors associated with early diagnosis of gastric cancer.Methods Clinical data were retrospectively analyzed for 250 patients with early-stage gastric cancer (EGG) from 2005 to 2008, during which the concept of intra-epithelial neoplasia(IN) was adopted in our department. Results On preoperative endoscopic biopsy with pathological exam, there were 15 cases suspicious for cancer, 90 with high-grade IN(HGIN), and 15 gastric cancer. Postoperative pathological exam of the surgical specimen showed infiltrating early-stage cancer in 224 patients, of which 5(2.2%) were type Ⅰ(all were Tsm), 190 (84.8%) were type Ⅱ including Tm in 82 and Tsm in 108 patients, 29 were type Ⅲ (5 Tm and 24 Tsm). Twenty-six patients had non-infiltrating lesions(Tis).There were 184(73.6%)well-differentiated tumors, including 26 Tis, 58 Tm, and 100 Tsm. Lymphatic metastasis was identified in 21 patients, of which 2(2.3%) were Tin(all were poorly-differentiated) and 19 (13.9%) were Tsm. Lymphadenopathy was present in 15(7.9%) cases in type Ⅱ, and in 6(20.7%) in type Ⅲ. of the 90 cases with a preoperative diagnosis of HGIN, 24 were found to be Tis, 29 were Tin, and 37 were Tsm on postoperative pathological assessment. Conclusions Well-differentiation is the main histological type in EGC. The adoption of the concept of IN is associated with improved detection of EGC, which warrants further investigation.