早期胃癌的内镜下特征分析

目的探讨早期胃癌的内镜下特征。方法对2010年1月至2014年7月北京军区总医院消化科胃镜检查发现并经病理确诊的119例早期胃癌患者（130处病灶）和695例进展期胃癌患者（695处病灶）的临床资料进行回顾性总结，对比分析早期胃癌的内镜下特征。结果早期胃癌癌灶多位于胃窦部（34．6％，45／130），镜下形态分类以0-Ⅱc型最多见（55．4％，72／130），白光内镜下97处（74．6％）病灶可见色调发红、121处（93．1％）具有清晰的边界、46处（35．4％）边缘部有明显“毛刺征”、116处（89．2％）具有明显不规则的表面形态或颜色、35处（26．9％）表面可见并发的溃疡、57处（43．8％）可见自发性出血、108处（83．1％）周边背景黏膜有肠化／萎缩改变、23处（17．7％）表面可见白色不透明物质，病理分型以分化型为主（90．8％，118／130）；进展期胃癌癌灶多位于胃底／贲门部（39．1％，272／695），病理分型以未分化型为主（81．3％，565／695）。两者在病变分布和病理分型构成方面差异均有统计学意义（P〈0．05）。结论清晰的边界和表面不规则是早期胃癌的重要内镜下特征，胃镜检查时重视上述特点的观察将有助于早期胃癌的发现和诊断。

Endoscopic characteristics of early gastric cancer

Objective To retrospectively analyse and summarize the endoscopic characteristics of early gastric cancer detected at Beijing Military General Hospital. Methods All pathological confirmed ear- ly gastric cancer cases （119 patients, 130 lesions of early gastric cancer; 695 patients, 695 lesions of pro- gressive gastric cancer） detected at Beijing Military General Hospital from January 2010 to July 2014 were collected, and endoscopic characterizations were analyzed. Results The antrum was the most commonly af- fected in early gastric cancer eases（34. 6% ,45/130）. The most common macroscopic morphology was 0-IIc type（55.4% ,72/130）. Under white light imaging, 97 lesions （74. 6% ） were reddish and 121 lesions （93.1%） had obvious margins. Encroachment, a sign of invasion, could be observed in 46 lesions （35.4%） ; 116 lesions （89. 2% ） showed irregular surface; 35 lesions （26. 9% ） showed ulceration; spon- taneous hemorrhage was observed in 57 lesions （43.8%）, atrophic gastritis and intestinal metaplasia were found in 108 lesions （83.1%） , while white plaque of substance was observed in 23 lesions（ 17.767o ）. Early gastric cancers were mostly pathologically differentiated adenoeareinoma （90. 8% , 118/130 ） ; while progres- sive gastric cancer were commonly undifferentiated adenocareinoma（ 81.3% ,565/695 ）. There were signifi- cant differences in lesion distribution and pathological typing between the two diseases （ P 〈 0. 05 ）. Conclu- sion Clear margin and irregular surface are the important endoscopic characteristics of early gastric cancer, which will facilitate screening and diagnosis of this disease.