伴淋巴结转移的早期胃癌病理组织形态学研究

目的通过研究早期胃癌发展过程中组织形态学的变迁，预测其淋巴结转移的难易程度。方法以伴淋巴结转移的81例早期胃癌作为转移组，抽取81例不伴淋巴结转移者作为对照组，两组均含11例黏膜内癌，70例黏膜下癌，组织学分类及肿瘤部位相似，具可比性。将各组的肿瘤灶亚分类为表层部、浸润部，各病灶的病理组织形态学依据规范分为分化型、混合型、未分化型。对各病例相关因子进行统计学分析研究。结果浸润部较表层部组织分化程度低下者，转移组为40．7％，较对照组的11．9％为高。转移组表层部的分化型胃癌和未分化型胃癌，其浸润部同一组织学分化程度较对照组为低，其差异有统计学意义（分别为P〈0．01和P〈0．05）。转移组的表层部与浸润部的分化程度合致率为61．7％，明显低于对照组的77．8％，其差异有统计学意义（P〈0．05）。转移组的男女比率为1．9：1，较对照组的3．3：1为低，其差异有统计学意义（P〈0．05）。结论早期胃癌中，癌灶水平方向和浸润先端部的垂直方向组织学分化程度的变化更易出现。浸润部与黏膜同有层癌组织学分化程度不同者，尤其是组织学分化程度趋低下者易出现淋巴结转移。女性较男性更易出现淋巴结转移。     

早期胃癌的内镜识别与诊断

不同类型的胃癌,其形态表现各不相同。尤其是早期胃癌病灶黏膜的形态改变可自细微异常至显著病变,即使是有经验的专业人员也常常误判。浅表隆起较小的0-Ⅱa病灶通常局限于黏膜内。图1A示胃窦大弯匍匐状微隆病灶,表面均匀发红,手术病理证实为高分化腺癌,浸润黏膜肌。0-Ⅱa+Ⅱc型是较多见的一种早期胃癌形态,周     

22例早期胃癌内镜、病理及临床资料分析

目的探讨早期胃癌内镜、病理及临床特点。方法回顾分析我们近3年内22例确诊为早期胃癌的临床、内镜及病理资料。结果其中中青年人患者(年龄≤60)15例,老年患者7例;女性13例,男性9例;发生部位胃窦12例、胃角6例、胃体4例;Ⅰ型病灶3例,Ⅱa型3例,Ⅱb+Ⅱa型5例,IⅡa+Ⅱc型6例,Ⅱc型2例,Ⅲ型3例;病理分型印戒细胞癌10例,粘液癌6例,管状腺癌6例。结论中青年患者早期胃癌检出比例高于老年患者,胃镜联合超声胃镜将病灶切除后进行组织学检查是诊断早期胃癌的有效方法。     

早期胃癌内镜诊断进展

胃癌的死亡率位居全球肿瘤死亡率的第二位.早期胃癌(EGC)预后较好,而进展期胃癌预后较差,因此胃癌的早期诊断成为决定患者预后的关键.因目前胃癌的诊断主要依赖于胃镜下活检行组织病理学检查,所以胃镜下如何发现病灶并准确活检是胃癌早期诊断的关键.随着染色内镜、放大内镜、窄带成像内镜、共聚焦显微内镜等检查手段投入临床使用,EG...     

早期胃癌内镜诊断进展

胃癌的死亡率位居全球肿瘤死亡率的第二位。早期胃癌（EGC）预后较好,而进展期胃癌预后较差,因此胃癌的早期诊断成为决定患者预后的关键。因目前胃癌的诊断主要依赖于胃镜下活检行组织病理学检查,所以胃镜下如何发现病灶并准确活检是胃癌早期诊断的关键。随着染色内镜、放大内镜、窄带成像内镜、共聚焦显微内镜等检查手段投入临床使用,EGC的诊断率得到了有效的提高。此文就EGC内镜诊断进展作一综述。     

未分化型早期胃癌的内镜下诊治进展

虽然内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)是早期胃癌(early gastric cancer, EGC)淋巴结转移(lymph node metastasis, LNM)可忽略不计的标准治疗方法,但在未分化型早期胃癌(undifferentiated-type early gastric cancer, UD-EGC)的病例中,选择ESD要比分化型早期胃癌(differentiated-type early gastric cancer, DT-EGC)更为谨慎。这是因为UD-EGC的组织学表现出具有侵袭性生物学行为,但ESD治疗UD-EGC的长期结果可能是有利的。因此,ESD在UD-EGC中具有重要意义。本文就UD-EGC的内镜下诊治进展作一综述。     

早期胃癌内镜诊断现状及进展

目前新型内镜以及内镜下各种新技术的运用,使胃黏膜和黏膜下结构更直观、清晰,早期胃癌的早发现、早诊断有实现的可能.该文就现阶段内镜下早期胃癌诊断现状及进展作一简要综述.     

早期胃癌的内镜表现与病理学分析

目的探讨早期胃癌(DGC)的内镜和病理学特点，以提高其在内镜下的早期诊断率。方法对62例完整的早期胃癌病例资料进行分析。结果早期胃癌内镜下分布以胃窦为主，本组占46.77％(29／62)。病变分型以Ⅱc为主，本组占40．32％(25／62)。病变浸润深度：粘膜内癌占56．45％，粘膜下癌占43．55％。组织学分型以中分化腺癌占多数(51．61％)；粘膜内癌多为隆起型和表浅型(Ⅰ、Ⅱa、Ⅱc)，粘膜下癌中以凹陷型为多(Ⅱc及Ⅲ)；粘膜下癌胃周围淋巴结转移率高于粘膜内癌。结论内镜检查结合病理学分析对早期胃癌诊断及治疗方法选择有重要的临床意义。     

内镜治疗混合型早期胃癌的临床病理特征分析

目的　分析混合型早期胃癌的临床病理特征,比较不同优势比例混合型癌的内镜病理表现差异。方法　回顾性分析2015年1月—2020年12月于南京大学医学院附属鼓楼医院消化科接受内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗且术后病理诊断为混合型早期胃癌的43例患者临床资料,分析患者的内镜特征、术前诊断与术后病理的符合率,并比较分化优势组与未分化优势组的内镜病理表现差异。结果　混合型早期胃癌多见于60岁以上（55.81%,24/43）、男性（65.12%,28/43）、幽门螺杆菌现症感染（69.77%,30/43）患者,萎缩背景（79.07%,34/43）、胃下部（65.12%,28/43）病灶多见,内镜下色泽以发红或者混杂发红色调为主（76.74%,33/43）,病灶形态以0‑Ⅱc型为主（58.14%,25/43）,放大内镜下可呈现分化型与未分化型癌双重特点,仅16.28%（7/43）患者活检病理提示为混合型癌。术后病理提示分化优势组33例,未分化优势组10例,有15例（34.88%）患者出现黏膜下深层浸润,有3例（6.98%）患者淋巴管阳性。分化优势组在内镜下更具有清晰的分界线［78.79%（26/33）比4/10,χ2=7.753,P=0.012］,两组在性别、幽门螺杆菌感染、背景黏膜、病灶位置、内镜下形态、病灶长径、色泽及放大内镜下微结构和微血管表现方面差异均无统计学意义（P>0.05）。分化优势组病理类型以tub2+por组合最常见（78.79%,26/33）,未分化优势组以sig+tub2组合占优势（6/10）。内镜诊断分化为主型癌敏感度高（93.94%,31/33）,诊断未分化为主型癌特异度高（94.28%,33/35）。结论　混合型早期胃癌可通过内镜下定性诊断,术前准确判断分化优势及浸润深度困难,易出现术后病理升级的情况,故行ESD治疗应更加严格把握适应证。     

早期胃癌的内镜下治疗

随着内镜技术的不断进步,越来越多的早期胃癌可经内镜下治疗.本文简要地介绍了早期胃癌内镜下治疗的发展史.重点介绍了目前早期胃癌内镜下治疗最先进的方法一黏膜剥离术的特点、适应征、并发症及处理对策.     

形似良性病变的早期胃癌的临床研究

目的总结形似良性病变早期胃癌临床特点，提高早期胃癌的诊断水平。方法回顾分析2001～2006年我院经手术切除和病理检查证实，且内镜下形态改变类似良性病变的早期胃癌25例。结果25例患者平均年龄为（58．59±9．35）岁，男女患病率无显著差异（P〉0．05）。21例（86．00％）患者有不同程度的临床症状。分化型癌19例，未分化型癌6例。黏膜内癌19例，黏膜下癌6例，均无淋巴结及远处转移。在内镜检查时发现可疑恶性病灶者18例，7例为内镜诊断良性病变由活检病理意外发现，漏诊率28％。有22例次接受色素染色后放大内镜、内镜荧光早期胃癌诊断仪（ISF）、智能电子分光内镜（FICE）检查等内镜精检，内镜精检和常规内镜检查的首次活检阳性率分别为81．8％和52．00％。大体形态以平坦型和凹陷型为主，内镜表现与良性息肉或炎性增生；局部黏膜发红或退色；局部黏膜粗糙或颗粒样或糜烂及良性溃疡相似。结论形似良性病灶早期胃癌易误认为良性病变，常规内镜首次活检阳性率低，应进行内镜精检并积极随访复查，避免延误诊断和治疗。     

内镜超声联合传统内镜对早期胃癌浸润深度的预测及临床价值研究

目的 评估内镜超声联合传统内镜对早期胃癌浸润深度的预测价值及其对治疗决策的指导作用。 方法 2011年7月至2018年1月在宁波市第二医院经胃镜病理确诊为胃癌的患者,治疗前行传统内镜、内镜超声检查评估,对129例术后病理证实为早期胃癌的患者,评估内镜超声、传统内镜及两者联合预测早期胃癌浸润深度的敏感度、特异度、阳性预测值、阴性预测值、一致性和曲线下面积（AUC）;评估内镜超声、传统内镜单项检查及两者联合对早期胃癌临床治疗决策的准确性。 结果 对于黏膜内癌,内镜超声预测的敏感度、特异度、阳性预测值、阴性预测值、kappa值和AUC分别是75.00％、82.22％、88.73％、63.79％、0.536、 0.797;传统内镜分别为61.9％、93.33％、94.55％、56.76％、0.481、0.801;两者联合分别是85.71％、82.22％、90.00％、75.51％、0.666、0.850。对于黏膜下癌,内镜超声预测的敏感度、特异度、阳性预测值、阴性预测值、kappa值和AUC分别是51.11％、86.91％、67.65％、76.84％、0.403、0.697;传统内镜分别为57.78％、73.81％、54.17％、76.54％、0.311、0.678;两者联合分别是71.11％、90.48％、80.00％、85.39％、0.632、0.817。假设基于内镜超声、传统内镜单项检查及两者联合,129例早期胃癌患者选择合适治疗（内镜下切除或外科手术）的准确率分别是83.72％、68.22％和92.25％。 结论 在早期胃癌患者中采取内镜超声、传统内镜联合,对传统内镜评估为黏膜内癌的患者不再另行内镜超声评估,仅对传统内镜不能判定或评估为大于等于黏膜下癌的患者进行内镜超声再评估,能提高术前分辨黏膜内癌及黏膜下癌浸润的准确性,提高早期胃癌选择合适治疗决策的能力,有一定的临床意义。临床试验注册 中国临床试验注册中心,ChiCTR-DDT-13003299。     

早期胃癌的诊治进展

胃癌是严重威胁人类健康的恶性肿瘤,早期胃癌的诊断和治疗对改善患者的预后至关重要。消化内镜的发展和内镜治疗技术的进展为早期胃癌的早期诊断和微创治疗提供了可能。本文就早期胃癌的诊治进展进行总结,希望为消化内镜医师的工作提供帮助。     

Endoscopic surveillance strategy after endoscopic resection for early gastric cancer

Early detection of early gastric cancer(EGC)is important to improve the prognosis of patients with gastric cancer.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and high-frequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection,a therapeutic option for gastric intraepithelial neoplasia.Consequently,short-term outcomes of endoscopic resection(ER)for EGC have improved.Therefore,surveillance with endoscopy after ER for EGC is becoming more important,but how to perform endoscopic surveillance after ER has not been established,even though the follow-up strategy for more advanced gastric cancer has been outlined.Therefore,a surveillance strategy for patients with EGC after ER is needed.     

A study of metachronous cancer after endoscopic resection of early gastric cancer

Abstract

Objective. Endoscopic resection is commonly used for early gastric cancer (EGC) in Korea and Japan. There are only a few reports of metachronous cancer after endoscopic resection. The aim of this study was to identify clinical factors associated with metachronous gastric cancer after endoscopic resection. Methods. A total of 176 patients with EGC who had underwent endoscopic submucosal dissection (ESD) were periodically followed-up with endoscopic examinations from January 2004 to December 2007. The incidence and variable factors of metachronous gastric cancer were investigated in a retrospective study. Results. The median interval between the diagnosis of primary cancer and the diagnosis of the first metachronous cancer was 30 months (range 18–42 months). Metachronous gastric cancer had developed in nine patients (5.1%) during follow-up period and seven patients (4.0%) had synchronous gastric cancer lesions within 1 year of the initial endoscopic treatment. Annual incidence rate of metachronous cancer was approximately 3.3%. Antrum atrophy and old age were significantly associated with the incidence of metachronous cancer. The status of Helicobacter pylori, size, location and gross finding of lesion had no significant relationship with metachronous occurrence. Conclusions. We should examine more carefully older patients who have atrophic gastritis because secondary cancer including metachronous cancer might occur in remnant stomach after initial successful endoscopic resection. And prospective study will be needed for the optimal endoscopic surveillance interval.     

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

BACKGROUNDEndoscopic submucosal dissection (ESD) is an established technique for the treatment of early gastrointestinal neoplasia. Generally, multi-day (M-D) admission is required for patients undergoing ESD due to potential complications.AIMTo evaluate the feasibility of a same-day (S-D) discharge strategy for ESD of the esophagus or stomach.METHODSThe data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital. The propensity score matching (PSM) method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups. Intraoperative and postoperative parameters were compared between the matched groups.RESULTSAmong the 479 patients reviewed, 470 patients, including 91 in the S-D group and 379 in the M-D group, fulfilled the inclusion and exclusion criteria. Following PSM, 78 patients in each group were paired using the 1:1 nearest available score match algorithm. No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events (AEs). Tumor size, complete resection rate, and procedural duration were comparable between the groups. The S-D group demonstrated a significantly shorter length of hospital stay (P < 0.001) and lower overall medical expenses (P < 0.001) compared with the M-D group.CONCLUSIONThe S-D discharge strategy may be feasible and effective for esophagogastric ESD, and the procedural-related AEs can be managed successfully.     

Seven synchronous early gastric cancer with 28 lymph nodes metastasis

An 85 year male patient complaining epigastric discomfort was admitted.From the esophagogastroduodenoscopy,three early gastric cancer(EGCa)lesions had been identified and these were diagnosed as adenocarcinoma with poorly differentiated cell type.The patient underwent operation.From the post-operative mapping,however,additional 4 EGCa lesions were found,and the patient was diagnosed with 7 synchronous EGCa.Out of the 7 EGCa lesions,6 had shown invasion only to the mucosal layer and one had shown invasion into the 1/3layer of submucosa.In spite of such superficial invasions,28 of 48 lymph nodes had been identified as metastases.The multiple lesions of EGCa do not increase the risk of lymph node metastasis,but if their differentiations are poor or if they have lympho-vascular invasion,multiple lymph node metastases could incur even if the depth of invasion is limited to the mucosal layer or the upper portion of the submucosal layer.     

农村社区症状性筛选胃癌的临床研究

目的探讨农村地区症状性筛选胃癌,尤其是早期胃癌的重要性和可能性。方法2001年1月至2006年6月间在上海市南汇区航头社区卫生服务中心,对主诉为上腹隐痛饱胀不适的2 717例开展胃镜筛查胃癌研究。结果胃镜活检病理证实食管癌6例（0.22%）,胃癌73例（2.69%）;手术病理证实进展期胃癌66例（占检出胃癌的90.42%）,其中7例未发现转移,59例发现转移;早期胃癌7例（占检出胃癌的9.58%）。结论加强胃癌知识宣传,加强专业人员的技术培训,提高内镜下对早期胃癌的识别能力,农村基层医疗单位亦能检出一定数量的早期胃癌。     

白光内镜联合内镜超声对早期胃癌浸润深度的判断

目的:探讨术前应用白光内镜联合内镜超声检查(endoscopic ultrasonography,EUS)评估浅表胃癌浸润深度的价值。方法:回顾性分析2011年1月—2019年12月于首都医科大学附属北京世纪坛医院经胃镜病理确诊的浅表胃癌患者资料,将术前白光内镜及EUS资料完整,并在该院接受治疗的84例患者纳入研究。根...