胃类癌的临床、生物学行为特点及外科治疗（附16例报告）

目的探讨胃类癌的临床、生物学行为特点及治疗选择。方法对1980—2002年经病理证实的胃类癌16例临床资料进行分析总结．结果16例中5例术前经胃镜活检确诊，2例术中经快速病理诊断，9例为术后病理证实。有淋巴结转移者7例，其中6例直径大于2cm。全组均予手术治疗，其中1例行内镜下电灼切除术，4例行局部切除术，1例行胃大部切除术，6例行根治性胃大部切除术，3例行根治性全胃切除术，1例行姑息性胃大部切除术及肝固有动脉结扎术。随访1—10年，死亡6例，其中5例死于类癌复发伴广泛转移．结论胃镜检查是术前发现胃类癌的重要手段，病理学诊断是最后确诊的主要方法．胃类癌的大小对判断其良恶性有重要参考意义．术式选择应根据肿瘤大小、浸润程度、有无淋巴结及肝转移而定。     

胃癌术后切端癌残留的原因分析及预防对策

目的：探讨胃癌切除术后切端癌残留的原因及预防对策。方法：回顾性分析1998年1月—2009年5月946例行胃癌切除术患者的临床资料,对癌残留情况进行统计学处理。结果：胃癌切除术后切端癌残留率为6.24%（59/946）。姑息性胃癌切除术癌残留率与根治性胃癌切除术癌残留率差异有统计学意义（18.87%vs5.49%,P〈0.05）;全胃切除较远、近端胃大部切除术切端癌残留率高（13.95%vs4.38%,6.50%,P〈0.05）;BorrmannⅢ～Ⅳ型、分化程度低及淋巴结转移数目在7个以上者切端癌残留率较高（P〈0.05）,而患者年龄、肿瘤直径和肿瘤浸润深度与切端癌残留率无关（P〉0.05）。结论：姑息性切除、BorrmannⅢ～Ⅳ型、分化程度低及淋巴结转移数目在7个以上的胃癌易发生切端癌残留。重视术前胃镜及X线钡餐检查,结合术中探查情况决定切除范围,保证切缘距离,常规剖视标本,可疑时行术中冷冻检查是减少胃癌切除术切端癌残留率的有效措施。     

23例胃低分化神经内分泌癌的临床病理特点和预后分析

目的 探讨胃低分化神经内分泌癌的临床病理特点及其预后.方法 回顾分析复旦大学附属肿瘤医院腹部外科1996年1月至2007年12月收治的23例胃低分化神经内分泌癌的临床资料.结果 23例胃低分化神经内分泌癌占同期收治胃癌的0.52%.其中男18例,女5例,平均年龄62岁.22例为单发病灶,有16例肿瘤位于近端胃,肿瘤最大直径平均为6.8 cm;Ⅱ期3例,Ⅲ期12例,Ⅳ期8例.13例患者进行了根治切除,8例姑息切除,2例行探查和活检.21例切除的病灶中,18例（85.7%）有脉管浸润,16例（76.2%）有神经浸润,17例（81.0%）有淋巴结转移.全组患者随访3～63个月,平均生存期为17.7个月,1、2、5年生存率分别为47.8%、19.1%和4-3%.患者的生存时间与肿瘤的分期（P=0.014）和能否根治切除（P=0.001）有关;而与性别、年龄和肿瘤大小及位置无关（P〉0.05）.结论 胃低分化神经内分泌癌是胃恶性肿瘤中的少见病理类型,恶性程度高,预后差,肿瘤分期和能否根治切除是影响预后的重要因素.     

胃黏膜活检诊断高级别上皮内瘤变与手术病理对比分析

目的探讨胃黏膜活组织检查病理诊断高级别上皮内瘤变（IN）患者胃镜所见及与术后病理的关系。方法回顾分析51例经胃镜钳取活组织病理诊断为胃黏膜高级别IN患者的胃镜下表现．并对照分析其中33例接受外科手术切除标本的病理学检查结果。结果胃镜下有29例（56．9％）的病灶分布在胃窦部,11例（21．6％）在胃体,1例（2．0％）广泛累及胃窦胃体,其余10例分别在胃角和胃底：43例（84．3％）的浅表病灶形似早期胃癌样表现,另有8例（15．7％）的病灶形似进展期胃癌样。接受手术治疗的33例患者中,13例（39．4％）术后病理证实维持高级别IN的诊断,胃镜下病灶形态均为浅表病变,大小均不足20mm;其余20例（60．6％）术后则诊断为胃癌,其中早期胃癌14例．进展期胃癌6例。结论胃镜下胃黏膜活检诊断高级别IN的患者存在胃癌的概率高,应积极随访甚至手术干预。     

胃镜及CT检查对进展期胃癌手术可切除性的探讨

目的 探讨胃镜结合CT检查对进展期胃癌的术前分期及手术治疗的临床指导意义.方法 对182例进展期胃癌的术前胃镜并CT分期与手术结果进行对比.结果 胃镜活检低(未)分化腺癌和黏液腺癌手术切除率(64.1%)较低,弥漫浸润型胃癌的切除率(6.7%)明显低于肿块型(66.7%)和溃疡型(61.8%);CT分期总准确率为91.21%,CT诊断对胃周脏器受侵和(或)转移的敏感性为72.22%,CT对淋巴结分期的准确率为74.2%,敏感性为74.1%,特异性为74.3%,CT诊断对淋巴结分组比较模糊.结论 胃镜在进展期胃癌定性诊断方面有不可取代的优势,对进展期胃痛的大体分型和活检组织学诊断及治疗方式有指导意义.CT诊断对进展期胃癌的临床分期准确性对周围脏器的侵犯、转移及淋巴结转移的诊断均有很高的价值;CT对手术切除情况的判断优于胃镜检查.术前行CT检查,对手术治疗有重要指导意义.     

胃黏膜皱襞粗大的胃镜表现特点及病理诊断分析

目的探讨胃黏膜皱襞粗大的胃镜表现特点及病理诊断。方法回顾性分析2002年1月～2008年4月行胃镜检查发现的161例胃黏膜皱襞粗大的临床资料。常规胃镜下活检未能明确诊断可行内镜下黏膜切除术活检或超声胃镜下深凿活检。结果161例中慢性炎症79例（49.1%）,胃癌67例（41.6%）,恶性淋巴瘤11例（6.8%）,Menetrier病2例（1.2%）,急性炎症1例（0.6%）,未见明显病变1例（0.6%）;幽门螺杆菌阳性率42.2%（68/161）,其中胃癌幽门螺杆菌阳性率为34.3%（23/67）。行内镜下黏膜切除术活检15例（9.3%）：慢性炎症5例,胃癌5例,恶性淋巴瘤4例,Menetrier病1例。在胃黏膜皱襞粗大的病变部位分布上,全胃均有病变10例,胃底病变10例,胃体病变86例,胃窦病变5例,胃底和胃体均有病变31例,胃体和胃窦均有病变19例;其中10例全胃均有病变的病理诊断均为胃癌。胃癌与慢性炎症胃镜下均可表现为扩张性差（χ^2=10.093,P=0.001）、蠕动差（χ^2=19.116,P=0.000）、胃腔变窄（χ^2=18.159,P=0.000）、质地硬（χ^2=54.302,P=0.000）、质地脆（χ^2=6.132,P=0.013）、糜烂（χ^2=5.619,P=0.018）和溃疡（χ^2=22.743,P=0.000）,但两者以上表现的差异有统计学意义。结论胃镜下发现的胃黏膜皱襞粗大,诊断上以慢性炎症、胃癌和恶性淋巴瘤为主,偶见Menetrier病和急性炎症。病变部位以胃体居多,当全胃受累时多诊断为胃癌。诊断为恶性病变（胃癌和恶性淋巴瘤）的胃黏膜皱襞粗大胃镜下多合并溃疡,扩张性和蠕动性差。内镜下黏膜切除术活检是一种有效的方法,有助于进一步明确疾病的诊断。     

胃类癌的临床与病理分析

目的探讨胃类癌的诊断、病理学特点及治疗选择。方法对1980～2000年经手术和病理诊断的胃类癌22例临床资料进行分析总结。结果22例中8例术前经胃镜活检确诊,3例术中经快速病理诊断,11例为术后病理证实。全组均予手术治疗,其中2例行局部切除,8例行胃大部切除术,10例为根治性胃大部切除术,1例为全胃切除术,1例做了全胃切除加肝左叶切除术。随访1～10年,死亡9例,其中6例死于类癌复发伴广泛转移;1例伴有胃腺癌者死于胃腺癌复发和转移;1例术后经支气管镜证实合并支气管类癌,而后死于肝转移。结论胃镜检查是术前发现胃类癌的重要手段,病理学诊断是最后确诊的主要方法。胃类癌的治疗取决于肿瘤的大小、浸润程度及生物学行为     

早期胃癌的病理检查结果及手术临床病理特点分析

目的 分析早期胃癌的病理检查结果 及临床病理特点。方法 选取2017年1月至2021年12月期间本院收治的82例早期胃癌患者为研究对象，分析纳入患者的镜下活检结果和术中标本病理特点。结果 早期胃癌胃镜下癌灶主要分布于胃窦（41.46%）及胃体部（32.93%），胃底部（14.63%）和贲门部（10.98%）较少累及；浸润至黏膜下患者35例（42.68%）、黏膜内47例（57.32%）；癌灶直径<0.5 cm的患者共10例（12.20%），直视下分型共见六种类型，分别是隆起型（9.76%）、浅表隆起型（24.39%）、浅表平坦型（10.98%）、浅表凹陷型（31.71%）、凹陷型（15.85%）及隆起凹陷复合型（7.32%）。早期胃癌患者临床病理中组织学分型统计共有五种，其中高分化癌（34.15%）和低分化腺癌（47.56%）共计67例，中分化癌（8.54%）、粘液腺癌（6.10%）及印戒细胞癌（3.66%）构成比较小。82例患者共发生淋巴结转移10例（12.20%），其中未分化型9例，黏膜下癌8例，分化程度及浸润程度均与淋巴结转移有关（P<0.05）。结论 胃镜下活检与手术...     

胃癌穿孔的诊断与治疗（附28例报告）

目的　探讨胃癌穿孔的诊断与治疗。方法　对本院 2 8例胃癌穿孔患者的临床资料进行分析。结果　单纯穿孔修补术 (或加胃空肠吻合术 ) 9例 ,姑息性胃大部切除术 11例 ,胃癌根治术(一、二期 ) 8例。3种术式的中位生存期分别为 5 .5个月、15个月、2 2个月。大体类型多为溃疡型(2 3/2 8例 ,81.2 % ) ,病理多为低分化或未分化癌 (2 5 /2 8例 ,89.2 % )。结论　胃癌穿孔病例常表现为年龄偏大、溃疡及穿孔直径大等 ,应积极手术治疗 ,尽可能行根治术或姑息性胃大部切除术。     

早期胃癌淋巴结转移的研究

目的研究早期胃癌（early gastric cancer，EGC）淋巴结转移的规律。方法回顾性分析2001年6月-2005年7月手术治疗101例EGC的临床病理资料。结果16例（16％）伴有淋巴结转移的EGC均为胃下部癌。黏膜下癌淋巴结转移率为28％，黏膜癌为7％（P〈0．05）。微小胃癌未见淋巴结转移，小胃癌淋巴结转移率为5％。直径1．1～2．0cm及〉2．0cm胃癌的淋巴结转移率分别为15％及28％（P〈0．05）。高分化EGC未见淋巴结转移，中分化及低分化的淋巴结转移率分别为17％及20％。黏膜癌仅累及N1淋巴结，而黏膜下癌则可转移至N2。结论EGC淋巴结转移主要与肿瘤浸润深度、病灶大小有关。应根据淋巴结转移的风险合理选择EGC术式。     

胃癌胰头后淋巴结清扫术指征的探讨

目的 分析胃癌患者胰头后淋巴结(第13组)微转移率及转移规律,探讨第13组淋巴结清扫术的指征.方法 通过实时定量免疫荧光PCR法(RQ-PCR)检测研究组44例行D2胃癌根治术+胰头后淋巴结清扫术的胃癌患者术中切除的第13组淋巴结中胃癌特异性标志物CK20 mRNA的表达情况,另选取49例同期行标准D2胃癌根治术的患者作为对照组,对比分析两组患者的生存情况.结果 研究组44例中共有11例发生第13组淋巴结微转移,微转移率为25%.微转移与患者年龄、性别、原发肿瘤部位、原发癌灶大小、Bormann分型、肿瘤浸润深度无关(P>0.05),但与原发肿瘤病理类型相关(P<0.01),黏液细胞癌、印戒细胞癌患者容易出现第13组淋巴结转移.6例肝十二指肠韧带淋巴结(第12组)和11例肠系膜上血管旁淋巴结(第14组)转移的患者中分别有2例(F=23.694,P<0.01)和4例(F=13.756,P<0.01)出现第13组淋巴结转移,与其他各组淋巴结相比差异有统计学意义.两组的中位随访时间分别为448 d和419 d,研究组中无1例出现术后第13组淋巴结转移所造成的梗阻性黄疸,对照组中发现1例,但两组患者肿瘤复发率之间相比差异无统计学意义(x2=0.426,P=0.514).结论 对于黏液细胞癌、印戒细胞癌患者,或术中发现第12组或第14组淋巴结肿大的患者,应该在标准D2根治术的基础上施行胰头后淋巴结清扫术.     

Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer?

BACKGROUND: In Japan, wide resection with extended lymph node dissection has been performed for advanced cancer with good prognosis. Pancreaticosplenectomy with gastrectomy is performed to facilitate dissection of the lymph nodes around the splenic artery. We attempted to evaluate the effects of pancreaticosplenectomy and splenectomy with gastrectomy for advanced gastric cancer. METHODS: Gastric cancer patients underwent splenectomy with gastrectomy (78 cases), pancreaticosplenectomy with gastrectomy (105 cases), or gastrectomy alone (1,755 cases). Survival rates were compared among the three groups for each factor of the depth of invasion, stage, and curability. RESULTS: There were no significant differences among the three groups. Pancreaticosplenectomy or splenectomy with gastrectomy to dissect lymph nodes does not improve survival but is associated with severe complications. CONCLUSIONS: The spleen should be resected when a patient has clearly positive node metastasis around the splenic hilus and artery, and pancreaticosplenectomy be performed when the cancer lesion invades the pancreas.     

胃低分化腺癌合并印戒细胞癌睾丸转移1例报告并文献复习

目的:探讨我院1例罕见胃印戒细胞癌睾丸转移的临床病理特点,免疫组织化学在睾丸转移瘤与原发肿瘤鉴别诊断中的应用。方法:回顾分析了我院收治1例睾丸肿瘤患者,1年前曾行胃贲门癌根治性全胃切除术,术后病理报告提示低分化印戒细胞癌,术后未予以放化疗,此次外院睾丸穿刺活检病理报告为低分化腺癌浸润或转移,考虑患者的病情及预后,行患侧根治性睾丸切除术。结果:术中见睾丸略增大,约4cm×3cm×2cm,质地硬,颜色呈淡红色,附睾大小、质地无异常。术后病理证实胃低分化腺癌合并印戒细胞癌转移。随访半年,临床症状好转。结论:胃印戒细胞癌睾丸转移非常罕见,特定的免疫组织化学指标可以有助于诊断。     

Clinicopathological study of early gastric cancer--indication of conservative surgery and radical endoscopic treatment of early gastric cancer

Clinicopathological factors such as depth of cancer invasion, size, gross type, frequency of metastases to regional lymph nodes, and distant prognosis were evaluated in last consecutive 339 cases with solitary early gastric cancer. The conservative surgery, that is, subtotal gastrectomy with complete dissection of lymph nodes of group 1 and selective celiac group and partial bursectomy, would be indicated for early gastric cancers located in antrum or corpus. But if the metastasis to the group 2 lymph nodes is suspected during the surgery, it is necessary to dissect lymph nodes en bloc more than group 2. The results, concerning the type of early gastric cancer without lymph node metastasis and the indication of endoscopic treatment, were as follows; 1. Intramucosal cancer of elevated type less than 2 cm in diameter. 2. Intramucosal cancer of depressed type less than 1cm in diameter, without peptic ulcer within the lesion, and a differentiated tubular adenocarcinoma histologically. 3. Intramucosal cancer of flat type less than 2 cm in diameter. But it is difficult to detect the depth of cancer invasion and lymph node metastasis preoperatively. We would emphasize that endoscopic treatment should be indicated in the case for which surgical treatment is not indicated.     

Lymph node metastasis at the splenic hilum in proximal gastric cancer

We performed splenectomy on patients with macroscopic advanced gastric cancer located at the proximal part of the stomach to achieve complete D2 lymphadenectomy. The aim of this study was to clarify the survival benefit of splenectomy in the treatment of gastric cancer. The clinical records of 225 patients who underwent total gastrectomy with splenectomy for gastric cancers involving the proximal part of the stomach were analyzed retrospectively. Nodal involvement at the splenic hilum (no. 10) was detected in 47 cases (20.9%). All of these cases were macroscopically diagnosed as positive for serosal invasion or regional lymph node metastasis at the time of surgery. In considering the lymphatic pathway from the primary tumor to no. 10 lymph nodes, metastasis at lymph nodes along the lesser curvature (no. 3), the short gastric vessels, or the gastroepiploic vessels (no. 4) may be good indicators of no. 10 lymph node metastasis. The overall survival of 47 patients with positive no. 10 lymph nodes was extremely poor. However, when curative surgery was performed, the survival of no. 10 positive patients was not different from that of no. 10 negative patients. Thus, for patients with advanced gastric cancer located in the proximal part of the stomach, D2 lymphadenectomy with splenectomy is recommended when patients show macroscopic evidence of serosal invaded tumor with regional lymph node metastasis.     

72例早期胃癌的诊断、治疗及预后分析

目的探讨早期胃癌(early gastric carcinoma,EGC)的诊断、治疗及影响预后的因素。方法回顾性分析1995年6月至2002年6月我院EGC的临床资料。结果本组EGC共72例,肿瘤部位:贲门部1例,胃体13例,胃窦56例,双原发癌2例(胃窦加胃体,胃窦胃大弯加胃小弯)。黏膜内癌42例,黏膜下癌30例。肿瘤病理分型:低分化腺癌24例,中分化腺癌17例,高分化腺癌 5例,印戒细胞癌12例,低分化腺癌部分印戒细胞癌12例,局部黏膜癌变2例。淋巴结转移10例。 EGC患者多因上腹疼痛首诊。上消化道X线造影、B超、CT的EGC检出率分别为57％、3％和15％。胃镜检查68例,病理确诊率94％。全部患者接受D2胃癌根治术,18例术后化疗。1例肝、肺转移行导管介入治疗,1例骨转移。随诊0．5-9年,随诊率85％,5年生存率90％,死亡率3％。结论根治性手术治疗是EGC取得良好疗效的最佳途径。D2胃癌根治术是治疗EGC的标准术式。胃镜病理活检是EGC诊断的金标准。淋巴结转移率是影响EGC预后的主要因素。     

Recurrence in early gastric cancer

In a retrospective study of 503 cases of early gastric cancer, 17 of the patients had died of a recurrence of the gastric cancer and 72 had died of unrelated causes. The cumulative recurrence mortality rates were 2.2% at 9 years for mucosal cancer and 8.4% at 8 years for submucosal cancer. The recurrence patterns of early gastric cancer were hematogenic metastasis to the liver, lung, or bone (nine cases), recurrence from lymph nodes (three cases), and recurrence in the residual stomach (five cases). Submucosal cancers with a macroscopically elevated appearance, lymph node metastasis, and evidence of vessel invasion were the high-risk cancers for hematogenic recurrence, and adjuvant chemotherapy should be prescribed. Two cases of lymph node recurrence were attributed to inadequacy of lymph node dissection. Because metastasis to the group 2 lymph nodes was noted in 1.5% of cases of early gastric cancer and a macroscopic diagnosis of nodal status was inaccurate, complete dissection should be performed regardless of identification of metastasis. Five cases of recurrence in the residual stomach were attributed to overlooked lesions of multiple carcinoma and were detected at an advanced stage. Careful and regular postoperative follow-up is required to detect these recurrences at an early stage.     

双镜联合治疗早期胃癌的临床体会

目的:探讨胃镜、腹腔镜双镜联合治疗早期胃癌的安全性与可行性。方法:回顾分析近6年双镜联合治疗78例早期胃癌患者的临床资料。胃体、远端胃肿瘤非溃疡患者行内镜黏膜下剥离术,近端胃及胃体、远端胃肿瘤合并溃疡患者行双镜联合下腹腔镜胃楔形切除术。标本送快速病理检查。结果:为早期胃癌浸润至黏膜下层及肌层、伴有脉管癌栓、肿瘤直径>20 mm、低分化腺癌(包括印戒细胞癌)的30例患者行腹腔镜胃癌D2根治术,5例近贲门或幽门部位肿瘤患者行单纯胃大部切除术,43例患者仅行内镜黏膜下剥离术或单纯胃楔形切除术。根治患者术后淋巴结转移占全部病例的11.5%,术后均无并发症发生,患者痊愈出院。结论:双镜联合治疗早期胃癌安全、患者创伤小、康复快、疗效确切,更加体现了微创优势,避免了部分患者不必要的根治切除甚至全胃切除的痛苦,值得临床推广。     

The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach

While proximal gastrectomy is often performed for early gastric cancer in Japan, it remains unclear whether or not proximal gastrectomy should be performed for advanced gastric cancer. This study was designed to determine the operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach. A total of 1691 patients with gastric cancer were reviewed retrospectively from hospital records during the period from 1969 to 1994, and the clinicopathologic characteristics of 82 patients who underwent proximal gastrectomy were compared with those of 150 patients who underwent total gastrectomy. Lymph node metastasis along the lower part of the stomach was observed in gastric cancers which had invaded beyond the muscularis propria of the stomach, but not in those confined to the muscularis propria. Three patients with gastric cancer that had invaded beyond the muscularis propria and metastasized to nodes along the lower part of the stomach were cured by total gastrectomy. However, there was no difference in the postoperative survival rates of the patients treated with proximal gastrectomy and those treated with total gastrectomy, irrespective of tumor stage and depth of invasion. Thus, proximal gastrectomy should be performed for gastric cancer when the depth of invasion is confined to the muscularis propria of the stomach.     

Twenty-two metachronous multiple signet-ring cell carcinomas treated with repeated gastrectomies and repeated endoscopic mucosal resections: Report of a case

A 45-year-old Japanese woman underwent an endoscopic mucosal resection (EMR) for early gastric cancer at the Cancer Institute Hospital in July 1996. The patient then underwent a distal gastrectomy in 2002 because of a new early gastric cancer and repeated EMR for a total of six early gastric cancers in 2007. Finally, a total gastrectomy was performed in February 2008. The pathological examination of the resected specimen indicated 14 synchronous multiple early gastric cancers. Although the incidence of multiple gastric cancers has been reported to range from 5% to 15%, there is usually only a double or triple lesion. Moreover, multiple gastric cancer is typically observed in male elderly patients as differentiated adenocarcinomas. The present case was a young female patient and all of the lesions were intramucosal signet-ring cell adenocarcinomas. The carcinogenetic mechanism in this case may therefore be different from that in typical multiple gastric cancers. A thorough preoperative examination and regular postoperative follow-up are therefore essential for detecting multiple gastric cancers in their early stages.