内镜下诊断早期胃癌506例

１　临床资料我院１９７３０４／１９９６０３经手术后病理证实的５０６例早期胃癌．男３６８例，女１３８例．年龄１９岁～８４岁，平均５４－７岁．病程最短者无症状，仅体检时发现，余病程＜０－５ａ～３０ａ，不论病程长短均有近期症状加重史．以疼痛（３６５例）、胀（２６７例）、瘦（１８４例）、嘈（１７３例）、纳减（１５９例）、嗳气（１４９例），呕血和（或）黑便（１２９例）为常见症．２　结果５０６例中７例为双中心癌，病灶共５１３个，窦部１８５个，角切１４０个，胃体７９个，贲门５７个，幽前区５２个．其中小弯３…     

老年人早期胃癌85例临床及内镜诊断

目的：回顾性分析85例老年人早期胃癌的临床及内镜资料，以提高其诊断水平。方法：将我院1989年－1999年经内镜诊断早期胃癌85例，从性别、临床特点、病理分型、病灶大小、内镜下分型等方面进行分析。结果：老年人早期胃癌男性68例，女性17例，年龄60－91岁，平均年龄69．5岁。临床多见不规则的上腹隐痛、饱胀、食欲减退、吞咽不适、消瘦、黑便等非特异性症状。病变部位：胃窦癌36例；胃体癌16例；胃角癌18例；胃底癌5例；贲门癌10例。内镜下分型：Ⅰ型1例，Ⅱa型7例，Ⅱb型4例，Ⅱc型49例，Ⅱc＋Ⅲ型3例；Ⅱa Ⅱc型18例，Ⅱc＋Ⅱa型3例。结果凹陷型最多，平坦型较少见。病灶大小：小于5毫米的微小胃癌10例；5－10毫米25例；11－20毫米35例；大于20毫米15例。病理类型：重度不典型增生伴灶性癌变14例；高分化腺癌10例；中分化腺癌38例；低分化腺癌12例；粘液腺癌11例。结论：（1）对临床上不规则的中上腹痛、腹胀、乏力、纳差或首发黑便或大便隐血阳性、吞咽不适等症状的患应予做胃镜检查，以排除早癌可能，尤其是有胃癌疾病的老年人应扩大内镜检查指征，以提高老年人早癌的检出率。（2）要重视对癌前病变的定期随访和检测，尤其对胃息肉、胃溃疡、萎缩性胃炎和糜烂性胃炎伴不同程度肠化或不典型增生，应列为高危人群，进行定期密切随访。（3）提高对早期胃癌内镜下分型的认识与鉴别水平，同时强调内镜下对可疑病灶有多点、多次取材。     

提高普通内镜对早期胃癌的诊断水平

进入21世纪后,消化内镜诊断及治疗技术进入快速发展时期,放大内镜、高清内镜、显微内镜等新型设备相继涌现,为提高早期胃癌的诊治水平带来了曙光。然而,这些新设备在我国大多数基层医院仍难以普及。因此,在临床实践中,如何利用好普通内镜,提高普通内镜下诊断早期胃癌的技术水平,是     

42例早期胃癌的内镜诊断分析

胃癌的早期诊断和早期治疗，对于降低胃癌的发病率及死亡率具有重要意义。我院自1989年7月至2002年12门间，经胃镜活检并经手术或病理确诊早期胃癌42例，现对结果作一分析。     

早期胃癌的内镜治疗

近年开展的内镜粘膜切除术切除早期粘膜层胃癌是一项新的内镜治疗技术，在日本已广泛开展，完全切除率已达５０％－８０％以上，其并发症和复发率极低，使非手术治愈早期胃癌成为可能。本文主要介绍内镜粘膜切除术的适应证，最常用的几种操作方法，切除效果的判定标准，并发症及切除后疡溃疡的治疗，预后等方面的研究进展。     

早期胃癌的内镜治疗

早期胃癌的内镜治疗山东医科大学（２５００１２）顾晓萌目前，早期胃癌的内镜治疗技术分为两类，即组织切除术和组织破坏术（包括激光、微波、电凝电切和纯酒精注射等）。前者是内镜治疗早期胃癌的首选方法，可以达到根治的目的；后者虽能破坏癌肿组织，但无法进行病理组...     

早期胃癌的内镜诊断及内镜治疗

早期胃癌是指癌细胞浸润局限在胃的粘膜层及粘膜下层，而不管其浸润范围大小及有无淋巴结转移。1962年日本胃肠道内镜协会将早期胃癌分为三型，即1型（隆起型）、I型（表面型）、血型（溃疡型）。其中五型又分成了3个亚型，分别称为Ⅱa型，Ⅱb型，Ⅱc型。Ⅰ型指隆起高度大于5mm     

早期胃癌的内镜诊断和治疗

早期胃癌(EGC)定义为垂直方向的浸润不超过黏膜下层而无论有无转移的胃癌，即早期胃癌=黏膜癌(M癌) 黏膜下层癌(SM癌)。内镜下早期胃癌可分为(肉眼分类)Ⅰ型(隆起型)、Ⅱ型(平坦型)、Ⅲ型(陷凹型)，其中Ⅱ型可进一步细分为Ⅱa型(平坦隆起型)，Ⅱb型(平坦型)，Ⅱc型(平坦凹陷型)。一般EGC直径1～4cm，小于0．5cm者称微小胃癌。     

早期胃癌内镜诊断的变迁

本文介绍了日本早期胃癌内镜诊断发展的历史,早期胃癌定义和肉眼分类的发展,开启了早期胃癌的研究。随着内镜技术的不断进步,早期胃癌的筛查从X线逐步过渡到内镜检查,病变范围和浸润深度的诊断更加精细,内镜下发现的早期胃癌形态特点更加表浅、微小。理解这些变化有助于提高内镜下早期胃癌的诊断。     

浅表扩散型早期胃癌1例

病例：患者女,79岁,因“腹胀2年、伴中上腹隐痛6个月”于2011年5月6日入院。患者2年前进食后出现上腹部胀痛,可自行好转,故未予重视。6个月前无明显诱因下出现中上腹持续性隐痛,进食后明显加重,伴恶心呕吐,呕吐物为胃内容物,偶有便秘,无反酸嗳气,无呕血黑便。     

胃癌牙龈转移1例

病例：患者女,62岁,主诉“上腹痛2年,牙龈出血2个月”于2010年4月19日收治入院。患者2午前于本院行肖镜检查并取活检,病理结果：（胃体）低分化腺癌（见图1）,免疫组化检查：Ki-67（＋）、CK（＋）、CEA（＋）。诊断“胃癌”明确,遂行胃癌根治术,术后未行后续治疗。患营诉间断上腹隐痛,服用药物不洋。2个月前自觉口腔右下颌磨牙区出现一包块,约黄豆大小,咀嚼时稍感小适,无疼痛。肿物生长较快,就诊时已有鹌鹑蛋大小,并时有出血,可自行停止。入院检查：全身一般情况好,左锁骨上方町扪及数个黄移大小的淋巴结,质硬,黏连,小可推动。心肺佥体未发现异常。     

胃结节病1例

病例：患者女，58岁，因“剑突下疼痛、上腹胀1年，加重1个月”于2006年3月12日来院就诊。患者有胃病史1年余。初次发作时无明显诱因，时有剑突下疼痛、上腹胀、嘈杂、胸骨后不适、反酸，无恶心、呕吐，无发热、盗汗，无体质量减轻。饮食、睡眠情况良好，大小便正常。     

Heterotopic Gastric Mucosa: A Case Report

A case of heterotopic gastric mucosa in discrete nodules of the duodenum is presented. Its radiographic and endoscopic appearance is described. The light and electron microscopic features are analyzed. Ultrastructural examination of its organization, cellular and subcellular components revealed similarities to normal fundic gastric mucosa. The histological and clinical differences between heterotopic gastric mucosa and duodenal metaplastic change are discussed.     

胃梅毒1例

病例：患者男,53岁,已婚,因“上腹痛伴消瘦1月余”入院。患者1个月前无明显诱因出现上腹痛伴反酸、烧心、厌食、乏力,恶心但无呕吐,近1个月体质量下降约5kg。为进一步诊治．于2011年2月9日入住大连市第三人民医院消化内科。     

Training in Early Gastric Cancer Diagnosis Improves the Detection Rate of Early Gastric Cancer: An Observational Study in China

Few studies have analyzed the training of endoscopists in the diagnosis of early gastric cancer (EGC). This study assessed whether specific training of endoscopists improves the detection rate of EGC.The rates of detection of EGC by endoscopists at the Digestive Endoscopy Center of the Affiliated Nanfang Hospital of China Southern Medical University between January 2013 and May 2014 were retrospectively analyzed. Because some endoscopists received training in the diagnosis of EGC, beginning in September 2013, the study was divided into 3 time periods: January to September 2013 (period 1), September 2013 to January 2014 (period 2), and January to May 2014 (period 3). The rates of EGC detection during these 3 periods were analyzed.From January 2013 to May 2014, a total of 25,314 gastroscopy examinations were performed at our center, with 48 of these examinations (0.2%) detecting EGCs, accounting for 12.1% (48/396) of the total number of gastric cancers detected. The EGC detection rates by trained endoscopists during periods 1, 2, and 3 were 0.3%, 0.6%, and 1.5%, respectively, accounting for 22.0%, 39.0%, and 60.0%, respectively, of the gastric cancers detected during these time periods. In comparison, the EGC detection rates by untrained endoscopists during periods 1, 2, and 3 were 0.05%, 0.08%, and 0.10%, respectively, accounting for 3.1%, 6.0%, and 5.7%, respectively, of the gastric cancers detected during these times. After training, the detection rate by some trained endoscopists markedly increased from 0.2% during period 1 to 2.3% during period 3. Further, the use of magnifying endoscopy with narrow-band imaging (M-NBI) (odds ratio = 3.1, 95% confidence interval 2.4–4.1, P < 0.001) contributed to the diagnosis of EGC.In conclusion, specific training could improve the endoscopic detection rate of EGC. M-NBI contributed to the diagnosis of EGC.     

A Case of Early Gastric Cancer Manifesting as a Submucosal Tumor

Abstract: Gastric cancer manifesting as a submucosal tumor (SMT) is not common. A gastric barium meal and endoscopic studies performed on a 49-year-old male with epigastric pain, revealed an elevated lesion with bridging folds and central depression on the posterior wall of the lower body. An endoscopic ultrasonography (EUS) revealed a hypoechoic mass lesion within the submucosal layer. Due to an increase in the size of the tumor and its central depression during the subsequent year and a half, the patient was admitted for closer examination. Endoscopic biopsy material from the deeper layer, obtained by mucosal resection, revealed a poorly differentiated adenocarcinoma. Microscopic examination of the resected stomach showed a poorly differentiated adenocarcinoma within the submucosal layer, with considerable lymphocyte infiltration. Immunohistological examination disclosed marked T cell infiltration adjacent to the cancer cells. We suggest that considerable lymphocyte infiltration, particularly T cells, may have some role in the protective reaction against cancer cells. Our case was diagnosed as being cancer 18 months after the first endoscopic study. The biopsy material taken from the depression at the time of the first examination showed benign findings and a EUS revealed typical SMT. In the case of SMT shown by EUS to be a hypoechoic mass lesion in the submucosal layer, it is recommended that biopsy material be obtained from the deeper layer using methods available such as artificial ulcer formation.     

Multiple Sleep Latency Test by Polysomnography: A Case Report

Obstructive sleep apnea syndrome may disguise the presence of other less common but equally important etiologies of sleepiness in patients presenting to sleep disorder specialists. In this case report the authors detail how multiple polysomnograms performed over 6 years eventually suggested that a patient had both obstructive sleep apnea and narcolepsy.