早期胃癌的影像诊断

早期胃癌(EGC)的准确诊断一直是影像学面临的挑战。X线气钡双对比造影、CT及磁共振成像(MRI)是诊断胃癌较为常用的影像学方法,本文对其在早期胃癌诊断应用的进展作一介绍。1早期胃癌的X线气钡双对比造影检查1.1常规应用及研究进展X线双对比造影检查是诊断早期胃癌的首选影像学方法,其操作简便无创,对胃整体形态的把握及特殊部位的检出能力是相对于内镜的优势所在。规范的双对比操作是保证早期胃癌检出的关键;综合运用充盈法、黏膜法、压迫法、双对比法和薄层法,充分发挥每种检查方法的优势,才能最大程度避免漏诊,提高早期胃癌的诊断水…     

早期胃癌诊断中的问题及可行对策

1962年日本学者提出早期胃癌，即胃癌细胞侵及胃黏膜层或黏膜下层，无论有无胃周淋巴结转移的胃癌。日本早期胃癌分为隆起型（I型）、浅表型（Ⅱ型）及凹陷型（Ⅲ型），其中浅表型又分为浅表隆起型（Ⅱa）、浅表平坦型（Ⅱb）及浅表凹陷型（Ⅱc）。但临床上见到的早期胃癌可以是混合型，即Ⅱa＋Ⅱc，Ⅱc＋Ⅲ等。胃癌是我国常见的多发病，其临床诊断的胃癌多数已经达到进展期，虽可通过手术治疗、化疗等方法治疗，但预后及生活质量往往不佳。     

胃壁脓肿一例

患者女，25岁,因反复上腹部疼痛10余年，加重7个月入院。1周前在当地医院行X线钡餐检查提示“胃底包块”。患病以来体重无明显变化，腹部检查无阳性体征。X线钡餐检查发现胃底一充盈缺损，边界清楚，直径约3cm（图1）．[第一段]     

在分析淋巴结转移的基础上决定早期胃癌的治疗对策

早期胃癌只要做恰当的胃切除，病人的5年存活率可超过90％。作者分析了1979～1996年间日本福冈九州大学医院外一科612例早期胃癌的临床病理学资料，包括术前和术中评价，主要的淋巴结转移，以确定和使用新的最恰当的治疗。全部病人均作DI和DZ胃切除，少数作D3胃切除。肿瘤肉眼分成三型；隆起型，扁平型或凹陷型。在组织学上，乳头状腺癌和管状腺癌归为分化腺癌，分化不良腺癌和印戎细胞癌归为未分化腺癌。47例为多灶性早癌损害。结果发现，早期胃癌总的淋巴结转移率为5．7％。有、无淋巴结转移与肿瘤的体积和侵犯深度有统计学显著差异，但…     

肠系膜上动脉压迫综合征的外科治疗

目的 对肠系膜上动脉压迫综合征(superior mesenteric artery compressing syndrome,SMACS)的诊断及术式选择进行评价。方法 对河南省人民医院2000年1月至2010年12月期间收治的28例SMACS患者的临床资料进行回顾性分析。结果 本组病例均行X线钡餐检查,有23例呈典型的十二指肠水平段与升段交界处纵行受压迫征象（笔杆征）。手术治疗28例,其中包括Treitz韧带切断松解术4例,单纯胃空肠吻合术2例,Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术11例,胃大部切除、胃空肠吻合术（BillrothⅡ式）7例及肠系膜上血管前十二指肠空肠吻合术4例。全部病例均治愈出院。结论 SMACS主要的确诊手段为X线钡餐造影。手术治疗效果以Treitz韧带松解加十二指肠空肠Roux-en-Y吻合术为最佳。     

早期胃癌的外科诊治体会

目的探讨早期胃癌的临床特点，指导临床诊治和提高疗效。方法对本院18例早期胃癌在诊断及治疗上的不同特点进行分析。其中14例有慢性胃病史2～30年，10例临床表现以上腹痛为主，2例表现为上消化道出血、进食哽噎。胃镜检查15例，上消化道造影检查10例。胃黏膜层(m)癌10例，黏膜下层(sm)癌8例，淋巴结转移3例。本组均行RI^ 或R2，其中远端胃大部切除14例，近端胃切除3例，全胃切除1例。结果全组无手术死亡。17例获得随访结果，随访率为94％。1年、3年、5年生存率分别为100％、94％和88％。结论及时发现和诊断早期胃癌是决定治疗方案和改善预后的主要因素。     

胃充盈超声检查诊断胃溃疡的临床价值

目的 探讨胃充盈超声检查对胃溃疡诊断的临床价值.方法 40例胃溃疡患者应用彩超结合胃超声助显剂充盈后行超声造影检查,并和X线钡餐检查、胃镜检查进行对照分析.结果 超声诊断胃溃疡符合率:定性82.5%(33/40),定位92.5%(37/40).检出胃周围淋巴结肿大15例.结论 胃充盈超声检查诊断胃溃疡具有无创伤、无痛苦、无放射、诊断准确性高、重复性好、病人易接受等优点,可作为临床胃溃疡初步筛查、药物治疗复查的首选方法,值得推广应用.     

糜烂性胃炎385例内镜分析

本文通过分析385例糜烂性胃炎(EG)的内镜表现、病理学检查及幽门螺杆菌(HP)感染发现：胃窦部EG发病率男女接近，胃底、胃体部男性明显多于女性。发病年龄均以30-70岁最多，平均年龄接近。分型上胃窦部多见隆起糜烂型和平坦糜烂型，胃底、胃体部多见平坦糜烂型。HP感染胃窦部占71．9％，胃底、胃体部占58．0％。HP总感染率为68．3％。2个部位均有1例早期胃癌。笔者认为内镜检查加上病理学及HP感染等检查，对本病具有重要的诊断价值，是发现早期胃癌的重要途径。     

进行期胃癌的X线诊断

近年来由于X线诊断技术的进步和普及,胃的微细病变诊断能力有了明显提高。利用充盈法、双重造影法(下称双重法)和压迫法进行组合,可以把直径10mm,高度1mm的微小胃粘膜病变显示出来,使早期胃癌的检出日益增多。但目前进行期胃癌的X线诊断,漏诊误诊情况仍占一定比例。我院自1980年1月至1984年6月手术切除的胃癌161例,漏诊7例,漏诊率4.3%。误诊4例,误诊率2.4%。漏诊的原因有:不按常规检查组合进行,省去三大检查法中的1～2个,依赖透视;X线漏检某些部位,如胃上部、幽门前区,共5例。不认征2例(癌浸润浅肌层)。有2例并发多量空腹胃贮留液。误诊例全部发生在溃疡形成性胃癌与良性溃疡的鉴别诊断上。现就如何提高X线正确诊断率,讨论三个问题。     

胃间质瘤临床分析

目的 探讨胃间质瘤的诊治方法。方法 回顾分析14周胃间质瘤的临床表现、病理特点、诊断及治疗情况。结果 14例中，7例位于胃体底部，7例位于胃窦部；主要的临床症状为腹部疼痛；均经胃镜、胃肠钡餐、CT及B超等检查发现。14例均经手术切除，病理组织学显示良性8例（57．1％），不确定型5例（35．7％），恶性1例（7.1%)；术后复发3例，死亡1例。结论 胃间质瘤的治疗以手术为主，术后应长期密切随访，对复发或转移者可多次行姑息切除。     

气钡双重造影在结肠癌诊断中的应用价值

为探讨气钡双重造影在结肠癌诊断中的应用价值,回顾经气钡双重造影检查诊断为结肠癌的40例患者X线征象资料,并与手术及病理检查结果进行对比分析。结果显示,术后病理检查诊断,结肠癌39例,肠结核1例,气钡双重造影X线摄片诊断准确率为97．5％（39／40）;39例经病理检查证实为结肠癌的患者气钡双重造影X线摄片显示,肿瘤位于升结肠6例,肝曲8例,横结肠4例,脾曲2例,乙状结肠19例,与手术所见完全一致,准确率为100％。结肠癌气钡双重造影主要X线表现为软组织肿块、充盈缺损、腔内龛影、肠壁增厚、肠管狭窄、边缘僵硬、肠黏膜破坏中断。结果表明,气钡双重造影诊断结肠癌准确率高,而且操作简单、易于掌握,在基层医院具有较高的应用价值。     

早期胃癌的临床病理特征与治疗方法的选择

目的:分析早期胃癌的临床病理特征并据此探讨早期胃癌的治疗方式、范围和注意事项。方法:总结术后病理报告证实为早期胃癌79例(85个病灶)患者的临床表现、内镜、X线钡餐所见及病理检查结果,并对手术方式的选择进行回顾性的分析。结果:早期胃癌内镜病理活检79例,确诊胃癌71例(89.9% ) ,诊断为癌前期病变8例;X线钡餐4 8例,诊断胃癌2 5例(5 2 .1% ) ;病理示管状腺癌居多,癌周组织癌前病变发生率达92 % ,隆起型2 1例,凹陷型5 3例,平坦型11例;多发灶病例6例,广泛弥漫性早期胃癌4例,术后切缘阳性2例。根据病灶的临床病理特点分别选用粘膜下切除术、胃大部切除术和胃癌根治术(D1、D2 或D3 )。结论:对癌前病变有症状的高发年龄患者建议手术,手术的原则应该是完整切除病灶和清除转移的淋巴结,D2 胃癌根治术应是首选术式,对不同区域的多灶型患者、表浅弥漫型患者以及第三站淋巴结转移的患者应采取全胃切除或扩大根治术     

Impact of screening survey of gastric cancer on clinicopathological features and survival: retrospective study at a single institution

BACKGROUND: Detection of gastric cancer in an early stage is important to improve the prognosis of patients with gastric cancer. This study compared the clinicopathologic characteristics and surgical results in patients with asymptomatic gastric cancer detected by a screening program with those of patients with symptomatic cancer. The efficacy of 2 screening methods (barium meal and endoscopy) was also compared. METHODS: The subjects included 196 patients with asymptomatic gastric cancer detected by screening (screening group) and 612 patients with symptomatic gastric cancer (nonscreening group) treated from 1979 to 1997. The screening group was subdivided into the barium meal study group (n = 150) and the endoscopic study group (n = 46). RESULTS: The incidences of early gastric cancer and 5-year survival rates between the screening and nonscreening groups were 77% versus 29% (P <.0001) and 81% versus 44% (P <.0001), respectively. The endoscopic study appeared to be able to detect smaller gastric cancer in an earlier stage compared with the barium meal study, although no statistical differences in survival rate were noted between these 2 screening methods. CONCLUSIONS: Screening plays an important role in detecting gastric cancer in an early stage and in potentially reducing death attributable to gastric cancer. Endoscopic screening is recommended as the best screening method.     

影像检查对小肠肿瘤的诊断价值

目的探讨影像检查在小肠肿瘤的诊断价值。方法收集经手术后病理证实的平滑肌(肉)瘤9例,血管瘤8例,腺癌6例。其中17例行小肠钡餐造影,12例行肠系膜上动脉造影。结果小肠钡餐造影检查。9例小肠平滑肌肿瘤;表现为肠腔充盈缺损,小肠局部受压移位,肠壁不光滑或/和小肠围绕征,肠系膜上动脉造影显示肿瘤血管增生和肿瘤染色。6例小肠腺癌;表现为小肠管腔狭窄或不规则狭窄,充盈缺损。8例血管瘤小肠血管瘤显示供血动脉及分支增粗,血池,回流静脉增粗。结论小肠钡餐造影应为首选方法。下消化道出血则可行肠系膜上动脉造影。     

胃大部分切除术后残胃癌19例临床分析

目的：探讨残胃癌的早期诊断方法和手术处理方式。方法：对19例残胃癌的临床病理资料进行回顾性分析，比较胃镜和钡餐对残胃癌的诊断价值。观察根据术中探查情况采取不同手术方式对预后的影响。结果：胃镜对残胃癌的诊断率为78.9%，钡餐为47.4%。手术切除的8例中根治性残胃切除5例均存活≥3年；姑息性切除的3例，术后存活2年2例，18个月1例。行胃空肠吻合6例中4例于6个月内死亡，2例分别存活12.5个月和14个月。5例腹腔内广泛转移者仅行肿块活检术。结论：胃镜对残胃癌的诊断价值优于钡餐。根治性残胃切除患者预后较好。     

Clinicopathological study on minute- and small-gastric cancer--growing pattern in incipient phase of gastric cancer development and its clinical significance

A clinicopathological study was performed on 13 cases of minute gastric cancer (14 lesions) with a diameter less than 5.0 mm and 33 cases of small gastric cancer (34 lesions) with a diameter between 5.1 mm and 10.0 mm. The incidence of flat lesions, multiple cancer and differentiated adenocarcinoma was more frequent in minute and small gastric cancer than in ordinary early gastric cancer with a diameter greater than 11 mm. The incidence of submucosal invasion in single cancer case (30.6%, 11/36) was significantly higher than that in multiple cancer case (8.3%, 1/12). The size of the smallest lesion invading the submucosal layer was 3.2 mm in diameter. Histological examination of the cancer lesions revealed that differentiated adenocarcinoma began to develop at the deeper mucosal layer, while undifferentiated adenocarcinoma did at the superficial mucosal layer. It was also demonstrated that the differentiated adenocarcinoma invaded the submucosal layer through the natural crevices of lamina muscularis mucosa. Pathological and mucohistochemical analysis of both the cancer cells and the surrounding mucosal tissue showed that intestinal metaplasia of the mucosa, especially mucohistochemically incomplete type metaplasia seemed to have close relation with the histogenesis of the differentiated adenocarcinoma.     

Outcomes of Mass Screening for Gastric Carcinoma

Background Therapeutic results of gastric cancer have been improved by early detection of gastric cancer with the mass screening system in Japan. The objective of our study was to assess the efficacy of mass screening for gastric cancer by using a barium meal. Methods A series of 1050 patients (364 in the screened group and 686 in the nonscreened group) were included in this study from April 1992 to March 2000. Patient characteristics, therapeutic results, and prognostic factors were compared in the two groups. Results The screened patients tended to be younger and male, with tumors in the middle third of the stomach that were of a macroscopically superficial type, with a smaller diameter, and at an earlier stage. They had fewer metastatic lymph nodes and underwent more frequent curative resection. Among the screened patients with curatively resected disease, tumors tended to be of a smaller diameter, and there were fewer metastatic lymph nodes in both early and advanced cases. Disease-specific survival was significantly better in the screened cases among all registered and curatively resected patients. Mass screening achieved significantly better surgical results in early or advanced gastric cancer patients who received curative resection. Multivariate analysis revealed that mass screening was an independent prognostic factor (hazard ratio, .3949; P < .0001), together with depth of invasion, lymph node metastasis, age, and tumor diameter. Conclusions Mass screening by using barium meal examination for gastric cancer detects cancer at an early stage and produces good therapeutic results.     

多发胃癌的诊断和处理

目的:分析胃癌外科诊治中多发胃癌的漏诊及其处理。方法:回顾性分析2000年3月～2004年2月间收治的830例胃癌中9例多发胃癌病人的诊治过程。结果:9例中,术前行胃镜检查者8例,行GI检查者6例,均未诊断出同时有两处病灶存在。4例为术中发现,另5例为术后病理检查所证实。两处癌灶大体分型相同者6例,不同者3例。两癌生长在相同区域者5例,不同区域者4例。组织学类型相同者7例,不同者2例。两处癌灶均为早期胃癌者1例,均为进展期胃癌者6例,早期与进展期并存者2例。18处癌灶中,局限于黏膜下层者4处;侵及肌层者4处;侵犯和(或)突破浆膜者10处。主、副癌灶间的间距为0.8～4.3cm,且病理连续切片证实两病灶间无联系,为非扩展浸润所致。术后随访6～24个月,1例残胃复发再手术。死亡5例,均为腹腔或淋巴结转移。结论:内镜、放射科、外科、病理科等相关医师应认识存在胃癌多发病灶之可能,并予重视,以减少和避免漏诊。     

Accuracy of identification of early gastric cancer

Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.     

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.