胃肠道癌的诊断与治疗早期胃癌的诊断与治疗

早期胃癌指病变不论大小、淋巴结有无转移,局限于粘膜层和粘膜下层的胃癌。有人称之为粘膜和粘膜下胃癌,也有人因为其属浅层而称之为浅表型胃癌。早期胃癌一旦确诊并予以根治,则5年生存率可达90%左右。日本早期胃癌的检出率较高,早期胃癌已占全部胃癌中的50%。近年来,国内...     

内窥镜下刚果红试验测定早期溃疡型胃癌的范围

在作者诊所开展的内窥镜下刚果红试验表明,溃疡型胃癌伴有大片泌酸区,癌肿主要位于紧靠泌酸区的非泌酸区,或被泌酸区所围绕,因而可以通过这一试验确定溃疡型胃癌的范围。本文报告35例早期溃疡型胃癌应用本试验的发现。病人及方法: 早期溃疡型胃癌(指病变限于粘膜或粘膜下层)病人共35例。术前先作纤维胃镜检查。胃镜进入胃内后,     

胃癌手术中淋巴结清除的作用

胃癌根治要求原发肿瘤的完全切除、胃周围受累器管的广泛截除以及淋巴结的充分清扫。预防性淋巴结清除对胃癌手术取得良好疗效具有重要意义。组织病理学组织学分类应既能反映胃癌的生长和转移方式,又能提示手术后的预后。通常,胃癌分为两种组织学类型,即癌细胞广泛播散而不构成腺体(小管)者以及癌细胞形成腺体者,分别称为未分化型和分化型腺癌。该分型确能与胃癌的扩散及临床预后相联系。日本则进一步分型,癌细胞存在于粘膜或粘膜下层称早期癌,侵入和穿透粘膜下层的为中晚期癌。早期癌分三型,即隆起、扁平与凹陷型。凹陷型又分两亚型:其一有不规则隆起明显地围以周围正常粘膜;另     

日本高分化型胃癌的细胞学分类

关于胃癌的组织学分型研究报告很多[1-3],但是由于近年来对胃癌组织粘液及酶类研究发现[4,5],由肠上皮化生粘膜为基础发生的胃癌大多数为分化型胃癌[6],少数为未分化型胃癌,它们多数是以分化型胃癌形式发生的,在其增殖过程中演变为未分化型胃癌的.     

结肠癌的病理特点—主要和胃癌比较

同样是消化道癌,结肠癌和胃癌由于组织学、癌发生的背景粘膜和腔内环境不同,癌的肉眼形态变化和组织学表现亦有其自身特点。试和胃癌作一比较,归纳结肠癌,特别是早期癌的病理特点与临床联系。 一、早期结肠癌隆起型多 迄今为止的资料显示早期结肠癌隆起型比凹陷型癌多;而早期胃癌凹陷型多,占 ２／３以上。这是因为：①结肠癌大多经“腺瘤－腺癌”途经（ａｄｅｎｏｍａ－ａｄｅｎｏｃａｒｃｉｎｏｍａ ｓｅｑｕｅｎｃｅ）发生,结肠腺瘤大部分呈高隆起,部分为扁平隆起;加上结肠粘膜层和粘膜肌很薄,肠蠕动易使腺瘤向腔内突出性生长。…     

Barrett食管的定义

1906年,Tileston报道了数例“食管消化性溃疡病”,他注意到溃疡周围粘膜与正常胃所见粘膜极相似。大多数学者认为此内衬柱状上皮的器官并非食管而是管状节段的胃,Norman Barrett则认为它是内衬柱状上皮的食管节段,此内衬柱状上皮的食管称为Barrett食管(BE),肉眼见BE有深浅腺体、小凹和绒毛。Barrett粘膜分三型:贲门型粘膜貌似胃贲门粘膜,但常有腺体扭曲、水肿及慢性炎症。胃底型     

胃镜诊断胃癌147例分析

胃镜诊断胃癌１４７例分析张长秀我院近十年来应用胃镜共检出胃癌１４７例，其中早期胃癌３例（２％），余为进展型胃癌。３例早癌均经活检及手术后病理证实，病灶仅限于粘膜及粘膜下层而无淋巴结转移者。现将资料总结如下：一、性别与年龄：１４７例胃癌中，男１１４例，...     

HP阳性浅表性胃炎与弥漫型胃癌的关系探讨

利用粘液组化法对２８２例胃癌活检标本进行分类，同时用硼酸美蓝蓝染色法对胃癌癌旁粘膜作组织切片检测ＨＰ。结果：１５０例肠型胃癌中其癌旁粘膜以萎缩性炎症为主，占７９．３３％，ＨＰ检出率为３６．６７％；１１６例弥漫型胃癌中，癌旁以浅表性胃炎为多见（６２．９３％），总ＨＰＢ是性率为５７．７５％，其中７３例癌旁少表性胃炎，６９．８６％见ＨＰ感染。同时发现青年组中弥漫型胃癌的发生率二倍于肠型胃癌。显示弥漫型胃     

BorrmannⅣ型胃癌超声内镜诊断价值的研究

目的:评价超声内镜(EUS)对 BorrmannⅣ型胃癌的诊断效果。材料与方法:138例胃癌病例术前均经内镜和病理活检检查。其中36例胃镜疑为 BorrmannⅣ型胃癌的病例术前同时做了 EUS 检查,结果与术后外科病理诊断进行对照。结果:胃镜检出的138例胃癌中,Borrmann Ⅰ型、Ⅱ型和Ⅲ型胃癌内镜活检多能明确诊断,第1次活检确诊率达88.5%以上。再次内镜活检取材,97.4%以上的病例能确诊。36例内镜可疑为 BorrmannⅥ型胃癌首次活检14例(38.9%)为粘膜炎症反应,未见癌瘤细胞。虽经再次活检,仍有12例(33.3%)未能获得明确诊断.该型胃癌在 EUS 下声像图常有特征性的变化,表现为大部分或全胃壁弥漫性全层增厚,粘膜下层尤明显,回声减弱。增厚的胃壁并无明显结构紊乱,其层次尚可辨认。根据这一特征,36例内镜疑诊为该型的胃癌病变均行 EUS 检查,均作出了正确的诊断,确诊率达100%。结论:EUS 能显示 BorrmannⅣ型胃癌特征性的变化,用于该型胃癌的诊断,优于内镜及活检检查。     

胃粘膜肠上皮化生与胃癌的关系研究进展

迄今为止,对胃粘膜肠上皮化生(下称肠化)是否属癌前病变仍无统一认识.多数作者认为肠化与胃癌,特别是分化型胃癌的发生有关.本文拟就国内外肠化与胃癌的关系研究进展作一综述.一、肠化的粘液组织化学特点胃肠道粘膜上皮分泌的粘液有两种:胃粘膜上皮分泌的中性粘液和肠粘膜上皮分泌的酸性粘液.后者包括由小肠粘膜分泌的氮乙酰唾液酸粘液及大肠粘膜分泌的氧乙酰唾液酸和硫酸粘液.通过粘液组织化学方法可将不同的粘液区别开来.一些学者根据肠化的粘液组织化学性质将其分为不同的亚型,探讨与胃癌发生的关系.     

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。     

Prevalence and characteristics of post-gastroscopy gastric cancer: A retrospective study from an academic medical center

Background and Study AimsGastric cancer is diagnosed by endoscopy but false negative rates of up to 10% in the west and 40% in Asia have been reported. In Lebanon, little is known about the rates of post-gastroscopy gastric cancer (PGGC), defined as the proportion of patients diagnosed with gastric cancer with a negative previous examination within 2 years of diagnosis. We aimed to examine the rate of PGGC and its risk factors, clinico-pathologic and endoscopic characteristics at a University medical Center.Patients and MethodsRetrospective analysis of patients with histologically proven gastric malignancy over the last 14 years. Patients with history of upper endoscopy preceding the index diagnostic endoscopy by 6 to 24 months were included.Results18,976 patients underwent upper endoscopy and gastric cancer was diagnosed in 323 (1.7%). Of those, only 4 (1.2%) had a preceding endoscopy within 6 to 24 months of diagnosis: 3 adenocarcinoma and one MALT lymphoma. Upon review of the initial endoscopy, a mucosal abnormality had been noted in all 4 patients and biopsies taken in 3 were negative for cancer. The mean time to cancer diagnosis was 8 months (range 6–13 months).ConclusionA small proportion of gastric carcinomas are missed on endoscopy in this study. Patients with endoscopic evidence of mucosal abnormalities and negative biopsies should undergo repeat examination with multiple biopsies. Proper endoscopic technique, lesion recognition and adoption of performance improvement measures are important to optimize endoscopic practice.     

Predicting histologic findings from endoscopic appearance of early gastric cancer.

In 156 cases of depressed early gastric cancer in the antrum or corpus, the differences between differentiated and undifferentiated carcinoma were studied by comparing the histological diagnosis of the resected specimens and their endoscopic appearance. We reached the following conclusions: (a) Younger patients more often had undifferentiated carcinoma (mean age: 59.8 years) than differentiated carcinoma (mean age: 77.2 years). (b) One hundred and twenty-five of 156 cases were limited to the mucosa and 29 cases were limited to the submucosa. (c) Undifferentiated gastric cancers more often invaded beyond the mucosa even when the tumor was small than did differentiated tumors. (d) Many differentiated tumors showed a smooth depressed surface, erythema at the edge of the cancer, and tapering of the gastric rugae. (e) In undifferentiated lesions the depressed tumor surface had a varied appearance, with various sized granules and nodules, as well as fading of the mucosal color and fusion of the rugae. It is important at endoscopy to consider not only whether a lesion is benign or a malignant, but also to consider its histological type. In particular, it is vital to detect small, undifferentiated gastric cancers as early as possible.     

早期胃癌及胃炎样早期胃癌诊治

目的:分析胃炎样早期胃癌临床诊治情况并总结经验。方法:收集2009年上海市3所医院内科门诊的早期胃癌筛查结果,同时收集2009年本院手术切除并经病理检查证实的早期胃癌中的胃炎样早期胃癌病例。结果:上海市3所医院施行胃镜检查41993例,胃癌805例,早期胃癌为158例,占胃癌手术患者19.6%,其中符合胃炎样早期胃癌8例,占早期胃癌患者5.1%。内镜下表现为充血(绯红)3例,表浅糜烂5例。手术病理证实Ⅱa型(浅表隆起型)1例,Ⅱb型(浅表平坦型)7例;黏膜下层1例,黏膜层7例。结论:加强对胃炎样早期胃癌的临床研究,尤其是提高胃镜下识别能力,以及开展色素胃镜、胃镜电子染色以及共聚焦激光显微内镜诊断胃炎样早期胃癌,有望进一步提高胃癌临床诊治水平。     

探讨胃粘膜低级别上皮内瘤变行ME-NBI的临床价值

目的：探讨活检胃粘膜低级别上皮内瘤变行ME-NBI的临床价值。方法：纳入2016.01-2018.06在我院门诊胃镜活检病理诊断为胃粘膜低级别上皮内瘤变患者148例,均行ME-NBI、靶向活检病理检查、超声内镜、腹部增强CT等检查及ESD治疗,详细记录检查结果及手术情况、ESD术后病理、并发症等资料。结果：ME-NBI检查、ME-NBI指导下靶向活检、ESD术后病理诊断癌性病变分别为19例、17例、20例、两两之间差异无统计学意义(P＞0.05)。以ESD术后病理为最终诊断结果,常规活检、ME-NBI检查、ME-NBI指导下靶向活检的癌性病灶漏诊率分别为13.51%、0.68%、2.03%,常规活检与ME-NBI检查、靶向活检的漏诊率差异有统计学意义(P＜0.05)。ME-NBI检查与靶向活检漏诊率差异无统计学意义(P＞0.05)。结论：活检胃黏膜低级别上皮内瘤变行ME-NBI是有必要的,能够提高早期胃癌检出率、降低漏诊率。     

What can we see with the endoscope? Present status and future perspectives

The present status and future perspectives in new technologies of image processing and analysis, infrared ray endoscopy and autofluorescence endoscopy for gastrointestinal cancer are presented in this paper. Spectroscopic measurements using an endoscopic spectroscopic system are useful for distinguishing between benign and malignant gastric mucosal lesions, and the histological classification of early gastric cancer is possible on the basis of the spectroscopic characteristics. It is expected that adaptive hemoglobin index color enhancement would be useful for the qualitative diagnosis of early gastric cancer and for detecting specialized columnar epithelium in Barrett’s esophagus in combination with magnifying endoscopy. Our preliminary experience suggess that magnifying endoscopy with a narrow‐band imaging system could predict the histological characteristics of gastric cancerous lesions with high accuracy. Recent studies revealed that infrared ray electronic endoscopy is very useful for diagnosing the depth of invasion in early gastric cancer. In addition, it is evident that specific antibodies tagged with the indocyanine green derivative can label cancer cells and can generate a fluorescent signal strong enough to detect small cancers using an infrared fluorescence endoscope. The future development and evaluation of autofluorescence endoscopy are discussed, and we propose a modification to the system, including the excitation lights.     

内镜窄带成像技术在胃癌及癌前病变诊断中的应用

目的 探讨内镜窄带成像技术(NBI)对胃癌及癌前病变的诊断价值.方法 217例患者依次在普通内镜、NBI、0.2%靛胭脂染色及内镜放大(×80)模式下观察病变轮廓、胃小凹及微血管形态,评价各检查方法图像的清晰度,并结合病理学检查进行分析.结果 217例患者中,非萎缩性胃炎85例,萎缩性胃炎38例,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,进展期胃癌20例,伴有肠化生者91例.NBI对病变轮廓的显示明显优于普通内镜和靛胭脂染色(P值均=0.000).经内镜放大后,NBI对胃微血管形态的显示亦优于普通内镜和靛胭脂染色(P值均=0.000).NBI模式下萎缩性胃炎胃小凹主要表现为Ⅲ、Ⅳ、Ⅴ1型,肠化生主要表现为Ⅲ、Ⅳ、Ⅴ1、Ⅴ2型,异型增生主要表现为Ⅴ1型及Ⅳ型,胃癌主要表现为Ⅵ型.结论 NBI电子染色结合放大技术有助于提高胃癌及异型增生的活检准确率和早期胃癌检出率.     

STUDY OF THE TUMOR VESSELS IN DEPRESSED‐TYPE EARLY GASTRIC CANCERS USING NARROW BAND IMAGING MAGNIFYING ENDOSCOPY AND CDNA ARRAY ANALYSIS

Background: Since endoscopic mucosal resection has been applied to differentiated gastric cancers with invasion limited to the mucosal layer, the diagnosis of their differentiation is important. The degree of differentiation varies depending on the size and location of the tumors. Correct diagnosis by biopsy can be difficult because depressed‐type early gastric cancers sometimes contain mixed histology. Methods: Fifteen patients with depressed‐type early gastric cancers were observed by magnifying endoscopy with a narrow band lighting system. The fine mucosal vascular pattern was recorded and compared with the histological differentiation and features of vessels by staining with CD34. In some patients, cDNA array analysis was performed to determine differences among histological types. Results: Tumor vascular patterns were classified into two categories. Grid‐like network patterns not only characterized differentiated type but were also associated with high microvascular density. Short twig‐like patterns typified the undifferentiated type and a low vascular density. Differentiated types highly expressed some angiogenic factors, such as VEGFc and Flt‐4. Conclusions: Tumor vessel pattern of depressed‐type early gastric cancer obtained by narrow band imaging magnifying endoscopy reflects both the histological features and the degree of expression of angiogenic factors.     

An Attempt to Analyze Color Wavelengths with an Electronic Endoscope

We attempted to measure the dominant wavelengths of gastric mucosal lesions and to extract and present color differences of the lesions in image form, by converting spectroscopic visual signals (composed of red, green and blue components) obtained from an electronic endoscope into digital color files. The dominant wavelength, as measured from signals input without gamma correction, was significantly shorter in gastric mucosa affected by atrophic gastritis and type lie early gastric cancer than in normal mucosa. This analysis revealed a significant difference in dominant wavelengths between the endoscopically normal mucosa of the stomach and that found to have been affected by early gastric carcinoma and atrophic gastritis. Color difference extraction allowed us to make a morphological characterization of the surface of type lie early gastric cancer, although this was possible in only one case. The results of this study suggest the diagnostic value of digital representation of the mucosal surface features provided by endoscopy. It is suggested that, in the future, analog endoscopic diagnosis will be replaced by digital endoscopic diagnosis and computerized endoscopic diagnosis.     

窄带成像结合放大内镜在早期胃癌诊断中的应用

随着消化内镜新技术的不断发展,提高了对胃黏膜微结构观察能力。胃黏膜病变时其表面形态会发生变化,根据其变化的特点,主要包含表面微结构和微血管结构的改变,可早期发现黏膜病变,并大致预测病理组织学类型。这对于胃癌前病变、早期胃癌的诊断和治疗具有重要的临床价值。本文就胃黏膜微结构与胃黏膜病变的关系,尤其与早期胃癌的关系,进行综述。