胃镜检出胃癌670例临床分析

目的 了解胃镜胃癌检出率,并对胃癌相关因素进行分析.方法 对2008年至2010年在我院经胃镜并经病理诊断为胃癌患者的临床资料进行回顾性分析.结果 本组确诊为胃癌的病例670例,检出率为5.21％,其中40岁以上628例(93.73％),男女之比为3.86∶1.670例胃癌患者中,常食咸菜、腌制食品及高盐饮食者670例、占100％,吸烟360例,占53.73％,长期饮酒237例,占35.37％.本组胃癌检出部位依次为胃窦373例(55.67％),贲门140例(20.90％),胃体112例(16.72％),全胃或大部分胃45例(6.72％).本组胃癌中幽门螺杆菌(Hp)阳性406例,阳性率60.60％.结论 胃癌胃镜检出率及Hp感染阳性率高,好发于胃窦部,40岁以上的中老年人占绝大多数,男性明显多于女性.根除Hp,少食咸菜、腌制食品,戒烟限酒,可有效减少胃癌的发生.     

1979-2008年青海地区经胃镜检出胃癌6362例

目的:了解青海省自开展胃镜检查以来胃镜检出胃癌的变化趋势.方法:回顾性统计1979-2008年胃镜检出胃癌患者的一般临床资料及胃癌的一般生物学特征,分析本地区不同民族、性别、时期胃癌的胃镜检出率,分析本地区胃癌的变化趋势.结果:近30年共检出胃癌6362例,总检出率为6.228%;检出胃癌患者男女比为3.594:1;汉、回、藏、撒拉、土、蒙古族胃镜胃癌检出率分别为:5.959%、8.519%、6.128%、6.868%、6.492%、3.876%;胃癌患者总平均年龄为55.40岁,其中男为56.19岁,女为52.65岁;胃窦部为本地区胃癌好发部位;近年来本地区胃镜胃癌检出率有降低趋势,但在土族与蒙古族患者中有升高趋势;近年来胃癌患者发病年龄逐渐增大,贲门癌发病有上升趋势.结论:本地区胃镜胃癌检出率高,胃癌患者平均发病年龄低,男性患者比例高,分化程度低,但总体来看,近年来胃癌检出率有所降低,平均发病年龄增高.     

近2年经胃镜检出胃癌601例临床病理分析

胃癌是消化道最常见的恶性肿瘤,我国胃癌的发病率占全部恶性肿瘤发病率的17.2%,死亡率仍居恶性肿瘤死亡率之首[1]。我院为三级甲等综合医疗医院,通过对近20年(1985年至2004年)间我院胃镜活检诊断为胃癌病例进行回顾性分析,以分析了解本地区近20年胃癌的动态变化规律,提高胃癌的     

甘肃省南部20年间汉回藏族人群胃镜检出胃癌分析

甘肃省为我国胃癌高发地区,尤以武威地区胃癌病死率最高,约为全国平均水平的5.61倍.目前甘肃省对胃癌的研究主要集中在武威地区,但尚无少数民族人群胃癌的调查研究报道.为了解甘肃省汉回藏族胃癌的发病状况,本文对甘肃省南部少数民族地区的汉回藏族人群进行了回顾性分析研究,旨在为病因研究和疾病防治提供帮助.     

天津滨海新区10年胃镜检出胃癌的临床流行病学分析

目的 调查天津滨海新区胃镜检出胃癌的临床流行病学特点.方法 统计2002年1月～ 2011年12月天津滨海新区5家医院胃镜和病理确诊胃癌患者的临床资料,对其主要的临床流行病学特点进行分析.结果 天津滨海新区10 a检出胃癌1 554例,总检出率2.47％,2002～2011年胃癌检出率分别为2.28％、2.32％、2.30％、2.34％、2.36％、2.40％、2.48％、2.50％、2.65％、2.64％;早期胃癌17例,仅占胃癌总数的1.09％;男1 191例、女363例,男女之比为3.28:1,2002～2011年检出胃癌中男女性别比分别为3.43、3.00、3.30、3.27、3.39、3.24、3.11、3.16、3.41、3.40:1;年龄17 ～96岁,平均59岁,发病高峰集中在50～69岁(68.24％),70岁后检出率逐渐下降;胃癌位于胃窦41.42％、贲门17.32％、胃底5.91％、胃角7.21％.结论 天津市滨海新区10 a中胃癌检出率呈上升趋势,男性多于女性,发病高峰集中在50 ～69岁,以胃窦癌为主,早期胃癌检出率低.     

近30年青海地区少数民族胃癌患者胃镜检出情况分析

胃癌是常见的恶性肿瘤之一,位居原发肿瘤的第2位[1],全世界约有35％的胃癌病例发生于我国[2].由于环境及遗传背景不同[3],胃癌在各民族之间存在差异.青海地区为我国胃癌高发区,也是少数民族聚集的地区.本研究回顾性分析我院内镜中心近30年胃镜检出的少数民族胃癌患者的临床资料,旨在了解胃癌在我省少数民族居民中的发病情况.1.资料及方法:选择1979年至2008年我院消化内镜中心胃镜活检病理确诊的少数民族胃癌患者.病理诊断根据WHO分类将胃癌分为乳头状腺癌、管状腺癌、黏液性和印戒细胞癌,并根据分化程度分为高分化型、中分化型、低分化型及未分化型.对胃癌患者的基本资料、内镜下表现、组织病理学特点进行分析,采用SPSS 13.0统计软件包处理数据,总结分析近30年胃癌发生发展情况,P ＜0.05为差异有统计学意义.     

429例胃癌流行病学资料分析

目的了解近5年来就诊于我院的胃癌患者相关流行病学资料的特点及变化趋势，为疾病的诊断与评估提供帮助。方法将2000年1月～2005年10月于我院住院治疗的胃癌患者（共计429例）列为研究对象，进行回顾性分析，对其一般资料、病理类型、发生部位、浸润深度等进行统计。以t检验分析确诊年龄与病理类型、发生部位、是否转移之间的相互关系；以，检验分析病理类型与发生部位、是否转移、抗幽门螺旋杆菌（H．pylori）抗体、H．pylori-CagA-IgG之间的相关性。结果①429例胃癌中，男性占73．6％（316例），女性占26．4％（113例）。平均年龄为62．48岁（19～93岁）。病理类型以低分化腺癌居多，占51．2％，印戒细胞癌占21．2％。发生部位以胃窦部居多，占45．7％，贲门胃底癌占11．9％。发病率无明显上升趋势。②在确诊年龄上，高度恶性组（低分化腺癌＋印戒细胞癌）（平均年龄61．41岁）与低中度恶性组（高分化腺癌＋中分化腺癌）（平均年龄64．82岁）存在显著性差异（P〈0．05）；胃体癌（59．60岁）与胃窦癌（63．0岁）存在显著性差异（P〈0．05）。转移组（61．73岁）与无转移组（61．05岁）无显著差异（P〉0．05）。③胃癌的病理类型与肿瘤部位、是否转移、H．pylori-CagA-IgG相关性：胃体癌组、已转移组、H．pylori-CagA-IgG阴性组恶性度高（P〈0．05）。病理类型与患者血清抗H．pylori抗体无明显相关（P〉0．05）。结论①胃癌多见于老年、男性患者，以低分化腺癌、胃窦部多见，印戒细胞癌有逐年发病增多的趋势，未见贲门癌发病率逐年上升趋势。②在胃癌患者中，病理类型恶性度较高者，相对较为年轻；发生于胃窦部者，年龄相对较大。是否已有转移与年龄无关。③发生于胃体部、已有转移、H．pylori-Ca-gA-IgG（-）者，胃癌恶性度较高。抗凡pylorl抗体与胃癌恶性度无关。     

胃镜检出胃恶性病变3460例分析

目的:探索胃镜检出胃恶性病变患者的发病及胃镜、病理特点。方法:对我院1990～2009年胃镜诊断的3460例胃恶性病变患者按不同年龄分组进行胃镜及病理资料的回顾性分析、总结。结果:3460例胃恶性病变患者中,男性多于女性(2.26∶1),但年龄≤40岁组男女差别不大。50岁以上发病明显增高,特别是60～70岁发病率最高。胃窦部为胃癌的高发部位,年龄≤40岁组以胃体和胃窦为主,而60岁以上患者胃贲门食管连接部癌的发病率显著上升。年龄≤40岁组病理类型以分化差、恶性程度高的低分化腺癌和印戒细胞癌为主,随着年龄增长,病理类型逐渐趋向于以中分化管状腺癌、高分化管状腺癌为主。胃淋巴瘤多发于胃体、胃窦部,胃镜下表现以多发性溃疡病灶为主。结论:胃恶性病变的发病与年龄、性别密切相关,不同年龄组胃癌的发生部位、病理特点各不相同,应引起重视,同时应提高对青年人胃癌的认识,提倡和重视胃镜检查普及,做到早期发现、早期诊断、早期治疗。     

Clinical epidemiology of gastric cancer in Hehuang valley of China:A 10-year epidemiological study of gastric cancer

AIM:To investigate the clinical epidemiological characteristics of gastric cancer in the Hehuang valley,China,to provide a reference for treatment and prevention of regional gastric cancer.METHODS:Between February 2003 and February2013,the records of 2419 patients with gastric cancer were included in this study.The patient’s characteristics,histological and pathological features,as well as the dietary habits of the patients,were investigated.RESULTS:The clinical data showed that adenocarcinoma was the leading histological type of gastric cancer in this area.Characteristics of gastric cancer in different ethnic groups and age showed that the 60.55-65.50years group showed the high incidence of gastric cancer in all ethnic groups.There were more male gastric cancer patients than female.Intestinal was the most common type of gastric cancer in the Hehuang valley.There was no significant difference in the proportion of sex in terms of Helicobacter pylori infection.The impact of dietary habits on gastric cancer showed that regular consumption of fried or grilled food,consumption of high-salt,high-fat and spicy food and drinking strong Boiled brick-tea were three important factors associated with gastric cancer in males and females.CONCLUSION:Differences existed in race,sex,and age of patients according to the epidemiology of gastric cancer in the Hehuang valley.Moreover,dietary habits was also an important factor contributing to gastric cancer.     

Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia

AIM:To investigate the predictive value of narrowband imaging with magnifying endoscopy (NBI-ME) for identifying gastric intestinal metaplasia (GIM) in unselected patients. METHODS:We prospectively evaluated consecutive patients undergoing upper endoscopy for various indications, such as epigastric discomfort/pain, anaemia, gastro-oesophageal reflux disease, suspicion of peptic ulcer disease, or chronic liver diseases. Patients underwent NBI-ME, which was performed by three blinded, experienced endoscopists. In addition, five biopsies (2 antrum, 1 angulus, and 2 corpus) were taken and examined by two pathologists unaware of the endoscopic findings to determine the presence or absence of GIM. The correlation between light blue crest (LBC) appearance and histology was measured. Moreover, we quantified the degree of LBC appearance as less than 20% (+), 20%-80% (++) and more than 80% (+++) of an image field, and the semiquantitative evaluation of LBC appearance was correlated with IM percentage from the histological findings. RESULTS:We enrolled 100 (58 F/42 M) patients who were mainly referred for gastro-esophageal reflux disease/dyspepsia (46%), cancer screening/anaemia (34%), chronic liver disease (9%), and suspected celiac disease (6%); the remaining patients were referred for other indications. The prevalence of Helicobacter pylori (H. pylori ) infection detected from the biopsies was 31%, while 67% of the patients used proton pump inhibitors. LBCs were found in the antrum of 33 patients (33%); 20 of the cases were classified as LBC+, 9 as LBC++, and 4 as LBC+++. LBCs were found in the gastric body of 6 patients (6%), with 5 of them also having LBCs in the antrum. The correlation between the appearance of LBCs and histological GIM was good, with a sensitivity of 80% (95%CI:67-92), a specificity of 96% (95%CI:93-99), a positive predictive value of 84% (95%CI:73-96), a negative predictive value of 95% (95%CI:92-98), and an accuracy of 93% (95%CI:90-97). The NBI-ME examination overlooked GIM in 8 cases, but the GI     

The role of endoscopy in the management of hereditary diffuse gastric cancer syndrome

Hereditary diffuse gastric cancer(HDGC) syndrome is an inherited cancer risk syndrome associated with path-ogenic germline CDH1 variants. Given the high risk for developing diffuse gastric cancer, CDH1 carriers are recommended to undergo prophylactic total gastrectomy for cancer risk reduction. Current guidelines recommend upper endoscopy in CDH1 carriers prior to surgery and then annually for individuals deferring prophylactic total gastrectomy.Management of individuals from HDGC families without CDH1 pathogenic variants remains less clear, and management of families with CDH1 pathogenic variants in the absence of a family history of gastric cancer is particularly problematic at present. Despite adherence to surveillance protocols, endoscopic detection of cancer foci in HDGC is suboptimal and imperfect for facilitating decision-making. Alternative endoscopic modalities, such as chromoendoscopy,endoscopic ultrasound, and other non-white light methods have been utilized,but are of limited utility to further improve cancer detection and risk stratification in HDGC. Herein, we review what is known and what remains unclear about endoscopic surveillance for HDGC, among individuals with and without germline CDH1 pathogenic variants. Ultimately, the use of endoscopy in the management of HDGC remains a challenging arena, but one in which further research to improve surveillance is crucial.     

Comparing upper gastrointestinal X-ray and endoscopy for gastric cancer diagnosis in Korea

AIM:To compare the cost and accuracy of upper gastrointestinal(GI)X-ray and upper endoscopy for diagnosis of gastric cancer using data from the 2002-2004 Korean National Cancer Screening Program(NCSP). METHODS:The study population included 1 503 646 participants in the 2002-2004 stomach cancer screening program who underwent upper GI X-ray or endoscopy.The accuracy of screening was defined as the probability of detecting gastric cancer.We calculated the probability by merging data from the NCSP and the Kore...     

甘肃省2000～2002年AIDS流行病学分析

目的 通过对甘肃省2000～2002年艾滋病(AIDS)疫情、血清学和行为学监测情况分析，为制定甘肃省AIDS防制策略提供依据。方法 通过血清学、行为学和流行病学监测，分析甘肃省AIDS流行病学特征，提供防制措施。结果 2000～2002年共检出艾滋病病毒(HIV)感染者47例，AIDS病人9例，死亡6例。以青壮年为主，男女比例为2．6：1；传播途径以静脉注射毒品为主，占59．57％；57％的HIV感染者文化程度为小学以下。3年共完成重点人群监测393501人，检出HIV抗体阳性者47例，阳性率为0．12‰。吸毒人群共用注射器比例呈逐年上升趋势，2002年达20％。结论 甘肃省2000～2002年AIDS流行速度明显加快，高危人群高危行为增加，预计甘肃省HIV感染者将大幅度增加，需加大防制力度，防止进一步蔓延。     

Epidemiology of gastric cancer

The incidence and mortality of gastric cancer havefallen dramatically in US and elsewhere over the pastseveral decades.Nonetheless,gastric cancer remains amajor public health issue as the fourth most commoncancer and the second leading cause of cancer deathworldwide.Demographic trends differ by tumor locationand histology.While there has been a marked declinein distal,intestinal type gastric cancers,the incidence ofproximal,diffuse type adenocarcinomas of the gastriccardia has been increasing,particularly in the Westerncountries.Incidence by tumor sub-site also varieswidely based on geographic location,race,and socio-economic status.Distal gastric cancer predominates indeveloping countries,among blacks,and in lower socio-economic groups,whereas proximal tumors are morecommon in developed countries,among whites,and inhigher socio-economic classes.Diverging trends in theincidence of gastric cancer by tumor location suggestthat they may represent two diseases with differentetiologies.The main risk factors for distal gastric cancerinclude Helicobacter pylori(H pylori)infection anddietary factors,whereas gastroesophageal reflux diseaseand obesity play important roles in the development ofproximal stomach cancer.The purpose of this review isto examine the epidemiology and risk factors of gastriccancer,and to discuss strategies for primary prevention.     

内镜窄带成像技术在早期胃癌及异型增生诊断中的应用

目的探讨内镜窄带成像技术（NBI）对早期胃癌及异型增生的诊断价值。方法217例普通胃镜和（或）NBI下表现异常者,依次采用普通放大、NBI结合放大、靛胭脂染色并放大观察,评价各检查方法图像的清晰度,并在NBI模式下于改变最显著部位活检行病理学检查。胃癌和重度异型增生者行内镜超声检查（EUS）,早期胃癌和重度异型增生者行内镜下治疗或手术治疗。结果在观察病变轮廓方面,NBI与染色内镜或普通内镜之间差异均有统计学意义,NBI最清晰,尤其是对于局灶性浅表性病变的观察;对于胃小凹的形态观察,NBI或染色内镜均优于普通内镜;在对胃黏膜微血管的观察中,NBI具有绝对优势。217例中发现轻度异型增生19例,中度异型增生9例,重度异型增生4例,早期胃癌5例。NBI模式下,胃小凹形态分为6种类型,异型增生主要表现为Ⅴ1型及Ⅳ型,早期胃癌主要表现为Ⅵ型。NBI放大内镜下3例早期胃癌可见新生或粗大血管,其中2例观察到螺旋形毛细血管。结论NBI技术操作简便,对胃黏膜病变轮廓显示清晰,放大后更可清晰观察到胃小凹及微血管形态,有助于提高早期胃癌及异型增生的靶向活检准确率。     

Characteristics of gastric cancer in Asia

Gastric cancer(GC)is the fourth most common cancer in the world with more than 70%of cases occur in the developing world.More than 50%of cases occur in Eastern Asia.GC is the second leading cause of cancer death in both sexes worldwide.In Asia,GC is the third most common cancer after breast and lung and is the second most common cause of cancer death after lung cancer.Although the incidence and mortality rates are slowly declining in many countries of Asia,GC still remains a significant public health problem.The incidence and mortality varies according to the geographic area in Asia.These variations are closely related to the prevalence of GC risk factors;especially Helicobacter pylori(H.pylori)and its molecular virulent characteristics.The gradual and consistent improvements in socioeconomic conditions in Asia have lowered the H.pylori seroprevalence rates leading to a reduction in the GC incidence.However,GC remains a significant public health and an economic burden in Asia.There has been no recent systemic review of GC incidence,mortality,and H.pylori molecular epidemiology in Asia.The aim of this report is to review the GC incidence,mortality,and linkage to H.pylori in Asia.