黏膜下切除术(ESD)联合色素内镜在早期胃癌诊断中的临床应用价值研究

选择我院2014年7月~2015年7月收治的胃癌患者124例,所有患者均接受茶常规内镜检查和色素内镜检查,比较两种检查方法病灶的情况。后取活检标本,对疑似早期胃癌的患者行黏膜下切除术治疗,后送检病理,观察病灶大小、病理特征及侵犯深度。常规内镜检查124例患者中11例早期胃癌,其中4例为癌前病变、4为未分化型,3例为分化型。色素内镜检查124例患者中42例早期胃癌患者,其中31例癌前病变、5为未分化型、6例为分化型。色素内镜诊断癌前病变、分化型早期胃癌的准确率显著优于常规内镜,差异有统计学意义(P0.05)。黏膜下切除术联合色素内镜能够较为准确的确定早期胃癌,指导内镜下的胃黏膜病变活检,提高检出率,为胃癌治疗提供依据。     

色素内镜诊断早期食管癌17例临床分析

早期食管癌由于病灶微小,普通纤维胃镜肉眼观察易漏诊、误诊。而通过内镜下粘膜染色能清楚的显示病灶的形态、色泽、大小及周边粘膜的变化情况,有利于早期诊断治疗。现将我院经内镜下喷洒卢戈氏液诊断食管疾病的335例患者中,结合病理活检,诊断早期食管癌17例,总结如下。     

胃窦全层腺癌浸润内镜下活检失败原因分析

对此例患者内镜下幽门梗阻明显,曾行3次内镜下病灶部位活检未发现腺癌病灶,总结原因为今后的内镜活检操作及临床诊断提供参考。认为内镜下病理活检存在漏诊风险,因此临床操作需慎重仔细发现病灶。     

内镜FICE技术不同波长组合在早期胃癌中的诊断价值

目的探讨内镜电子分光图像处理(FICE)技术在早期胃癌中诊断及指导治疗的临床价值。方法使用内镜FICE技术对60例早期胃癌患者的142个病灶进行诊断观察,并行病理活检,将内镜FICE技术诊断结果与病理学诊断结果相比较。结果内镜FICE技术诊断隆起型(0-Ⅲ)、平坦型(0-Ⅳ)及凹陷型(0-Ⅴ)胃癌的病理符合率分别为91.7%、96.7%、87.5%,总病理符合率为95.0%。结论通过内镜FICE技术对早期胃癌患者黏膜及黏膜下观察黏膜表面的微细腺管形态及微血管形态,记录最佳波长组合,推测病变的组织类型及浸润深度,及时作出诊断及制定正确的治疗方法。     

胃印戒细胞癌内镜特点及临床诊治分析--附36例报告

目的 探讨胃印戒细胞癌的内镜及临床特点及诊断治疗方法。方法 对已明确诊断的36例患者进行回顾性分析，分析其临床特点、内镜表现、病理类型及治疗方法和结果。结果 胃印戒细胞癌好发于胃体中上部小弯侧前后壁。内镜下改变主要为局限性糜烂，颗粒样增生、结节样改变，质脆易出血或黏膜肥厚增粗。病理类型多为B-II、IIb及IIc，对可疑患者要多次、多部位、深挖取活检，能提高活检阳性率。结论 胃镜及病理活检仍是胃印戒细胞癌早期诊断有效可靠的方法，手术治疗为首选。     

早期大肠癌的内镜诊断体会

目的 讨早期大肠癌的内镜下特点，为早期诊断提供依据。方法 我院近25年来经内镜发现并术后病理证实的早期大肠癌64例为研究对象，对其内镜诊断作一系统回顾分析。结果 早期大肠癌的内镜检出率占同期大肠部的7.2％；84．4％位于乙状结肠以下；大体形态为：以I型最多见，其中IP型25例，Ips型8例，Is型12例，Ⅱa型7例，Ⅱa＋Ⅱc型9例，Ⅱc3例；组织学类型以高分化腺癌最多（44例，占68.8％），其次为中分化腺癌（14例，占21．9％）。结论 提高大肠癌的早期诊断率，临床和内镜医师务必做到以下几点：（1）临床医师提高对早期大肠癌的警惕性，放宽内镜检查指征；（2）提高内镜医师的检查技术与微小病灶识别能力；（3）放宽大肠粘膜活检指征，提高大肠粘膜活检质量与病理监测；（4）积极开展染色内镜和放大内镜检查技术；（5）重视大肠癌的内镜普查。     

胃黏膜高级别上皮内瘤变内镜下形态与术后病理结果的比较研究

目的研究胃黏膜高级别上皮内瘤变(HGIN)患者的内镜下特点,比较不同内镜下形态的病变内镜活检与术后病理诊断的差异。方法将2011年1月-2012年12月在该院消化内镜中心所检出的胃黏膜HGIN患者共124例纳入研究范围,对其进行回顾性研究,比较其内镜下表现特点与患者术后的病理资料。结果124例患者内镜下活检诊断为胃HGIN,内镜下形态粗糙糜烂型20例、溃疡凹陷型74例及增生隆起型30例,120例手术治疗患者术后病理结果 10例为炎性改变,18例为低级别上皮内瘤变(LGIN),34例为HGIN,58例诊断为癌,早期癌和进展期癌分别为34例及24例,24例进展期癌中,溃疡凹陷型例21例,病变3 cm患者20例。结论内镜下活检诊断HGIN,近50.00%已发生癌变,内镜下3 cm及溃疡凹陷型患者出现进展期癌风险增加,应采取外科手术治疗。     

放大色素内镜在大肠肿瘤病灶形态与性质评价中的应用

目的：探讨放大色素内镜在大肠肿瘤病灶形态与性质评价中的应用价值。方法对82例接受内镜下粘膜切除术的大肠肿瘤患者运用放大色素内镜，将凹陷肿瘤病灶分为1型凹陷和2型凹陷，同时按照内镜下粘膜切除术之后的病理检查结果，判断大肠肿瘤病灶的形态与性质。结果本组患者病灶发生表面凹陷40例，其中1型凹陷病灶25例，2型凹陷病灶15例。2型凹陷病灶轻度增生发生率显著低于1型凹陷病灶，腺癌发生率显著高于1型凹陷病灶（P＜0．01）；2型凹陷病灶与1型凹陷病灶粘膜切除术浸润深度比较差异有显著性（P＜0．01）。结论在大肠肿瘤病灶形态与性质的评价中，放大色素内镜可依据大肠肿瘤表面的凹陷程度来判断病灶的浸润深度和性质，为内镜下粘膜切除术提供了重要的诊断依据，值得临床推广应用。     

超声内镜在早期贲门癌及癌前病变治疗中应用价值

目的 探讨内镜超声检查术(EUS)在早期贲门癌及癌前病变治疗中的临床应用价值.方法 病理证实为高级别上皮内瘤变及黏膜内癌的贲门早期癌及癌前病变145例患者行EUS检查判断病变浸润深度,对符合治疗标准的患者行内镜黏膜切除术(EMR),术后病理结果与EUS结果进行对照分析.结果 EUS对早期贲门癌及癌前病变判断浸润深度与术后病理检查结果对照相符者127例,准确率为87.6％,其中对黏膜层癌前病变及早期癌判断的准确率89.5％,对黏膜下层癌前病变及早期癌判断的准确率76.8％;对固有肌层癌判断的准确率75.0％.结论 早期贲门癌及癌前病变患者治疗术前行超声内镜检查术可准确评估病灶内镜下切除的可能性,使内镜下黏膜切除更为安全有效,对指导早期贲门癌及癌前病变内镜下治疗具有重要价值.     

早期大肠癌的内镜临床应用研究

目的：探讨内镜对早期大肠癌的诊断及治疗价值。方法：对1984年1月－2000年1月经病理确诊的105例（106个病变）早期大肠癌的临床资料、诊断及治疗方式进行分析。结果：早期大肠癌多见于乙状结肠及直肠，肉眼形态以隆起型多见。大肠腺瘤癌变多具有以下特点：腺癌＞2cm；广基型；表面不平、糜烂；组织易破碎出血。对早期大肠癌先进行内镜下摘除，病理证实有下列之一者追加肠段切除或行根治性手术：切缘有癌组织；癌组织侵犯粘膜下层深层；癌组织分化程度差。结论：心便患者首选内镜检查。粘膜层早期大肠癌的内镜治疗与手术治疗有同样的效果，且损伤小、安全、方便。     

Endoscopic diagnosis of minute, small, and flat early gastric cancers

We reviewed the diagnostic process in 6 minute, 6 small and 9 flat early cancers detected preoperatively, and in additional 12 flat cancers that were found in resected stomachs only at histology between 1976 and 1986. The limit of the size of cancer detectable preoperatively was 4 mm. Endoscopically, 7 out of 12 minute and small cancers detected preoperatively showed obvious morphological changes, while the others showed only color changes with or without erosion. Lesions with morphological changes significantly invaded the mucosa more often than those with no such changes (p = 0.010). Among flat cancers, color change was significantly more frequently observed in cancers involving the whole mucosa than in those confined to the superficial part of the mucosa (p = 0.015). Redness and discoloration were significantly more frequent in the differentiated and undifferentiated groups, respectively (p = 0.005). This study suggests that morphological and color changes are important indicators of minute or small cancers, especially those involving the whole mucosa.     

Characteristics of metachronous multiple early gastric cancers after endoscopic mucosal resection

BACKGROUND AND STUDY AIMS: Endoscopic mucosal resection (EMR) of early gastric cancer is a minimally invasive procedure. The incidence and characteristics of metachronous multiple gastric cancers were investigated in a retrospective study in patients with early gastric cancer after EMR treatment. PATIENTS AND METHODS: A total of 143 patients with early gastric cancer who had undergone EMR treatment were periodically followed up with endoscopic examinations for 24 months or longer. RESULTS: The median period of endoscopic follow-up was 57 months (range 24 - 157 months). None of the patients died of gastric cancer, and there were no treatment-related deaths. Five patients died of other diseases. Of 20 patients (14 %) with metachronous multiple gastric cancers, 15 were treated by EMR. One patient with differentiated submucosal cancer and four with undifferentiated cancers underwent surgery. Sixteen patients (11 %) had synchronous multiple early gastric cancer lesions within 1 year of the initial EMR. About half of the multiple lesions were located in the same third of the stomach as the primary lesion, and most lesions were similar in macroscopic type to the primary lesions. Most multiple lesions were of the differentiated type. CONCLUSIONS: Annual endoscopic examinations can preserve the whole stomach in most patients with early gastric cancer after successful EMR.     

早期胃癌的临床病理特点与内镜下的表现分析

目的探讨早期胃癌的临床病理特点与内镜下的表现。方法选择该院2008年1月-2016年12月早期胃癌患者120例作为研究对象。收集患者的临床病理资料及内镜检查资料。结果早期胃癌患者年龄55岁占30.8%,≥55岁占69.2%,男性占63.3%,女性占36.7%,主要症状为上腹部隐痛和食欲下降,分别占40.8%和22.5%,主要组织学类型为低分化腺癌和中分化管状腺癌,分别占48.3%和27.5%,分化型52例,占43.3%,未分化型68例,占56.7%,淋巴结转移14例,占11.7%,黏膜内癌66例,占55.0%,黏膜下癌54例,占45.0%。内镜下表现:早期胃癌胃窦部、胃体部、胃底部、贲门部的构成比分别为49.2%、26.7%、12.5%、11.7%,病灶直径0.5 cm、0.5~1.0 cm、1.0 cm的构成比分别为14.2%、38.3%、47.5%,大体类型Ⅰ型、Ⅱa型、Ⅱb型、Ⅱc型和Ⅲ型的构成比分别为10.8%、25.8%、11.7%、35.8%和15.8%。早期胃癌的分化程度和浸润深度与淋巴结转移有关(P0.05),年龄、性别、病变部位、病灶直径、内镜下分型与淋巴结转移无关(P0.05)。结论早期胃癌男性多见,低分化腺癌比例高,内镜下见胃窦部好发,直径1.0 cm以上者较多,大体类型以Ⅱ型为主,未分化型癌和黏膜下癌淋巴结转移率高。     

Simultaneous multiple early cancers of esophagus and stomach treated by endoscopic mucosal resection

Endoscopic mucosal resection (EMR) has been accepted as a completely curative treatment of gastrointestinal mucosal cancers. With advances in diagnostic techniques, the tendency to detect simultaneous multiple primary cancers is increasing. Patients with another cancer coexisting with esophageal cancer have had a poor prognosis, but if both cancers are detected in the early stage, complete treatment consisting only of endoscopic surgery, with a good prognosis, is expected. We describe two cases of simultaneous multiple early cancers of the stomach and esophagus, treated by EMR.     

上消化道同时性多原发癌46例胃镜和临床特征分析

目的分析上消化道同时性多原发癌的胃镜和临床特点,提高早期诊断率。方法回顾分析了46例上消化道同时性多原发癌的临床及胃镜资料。结果本组病例发病高峰年龄为60~69岁,好发部位依次是食管、贲门、胃角。胃镜下可见癌灶以隆起型居多,其次是凹陷型,色泽变化是早期多灶癌最显著的特征之一。结论早期癌的发现对施行内镜下黏膜切除有重大意义,可疑人群的色素放大胃镜、超细胃镜的检查对上消化道同时性多原发癌的早期诊断很有价值。     

内镜黏膜下剥离术治疗早期胃癌及癌前病变的疗效分析

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌及癌前病变的疗效和风险。方法对2011年6月-2016年12月甘肃省武威肿瘤医院内镜中心经ESD治疗的206例早期胃癌及癌前病变患者的临床病理和随访资料进行总结,评价ESD治疗的一次性完整切除率、并发症发生率、复发转移率和临床疗效。结果 206例患者中早期胃癌157例(76.21%),其中m1 39例(24.84%)、m2 17例(10.83%)、m3 92例(58.60%)、sm1 4例(2.55%)、sm2 3例(1.91%)、基底部有癌肿累及2例(1.27%),胃腺管癌84例(53.50%)、中分化腺癌61例(38.85%)、乳头状腺癌5例(3.18%)、胃黏液腺癌2例(1.27%)、胃低分化腺癌5例(3.18%);高级别上皮内瘤变41例(19.90%);绒毛状管状腺瘤伴低级别上皮内瘤变8例(3.88%)。ESD整块切除率为99.03%(204/206),完整切除率为98.06%(202/206),组织学完整治愈率为98.06%(202/206)。术后迟发性出血7例(3.40%),术中穿孔5例(2.43%),术后出现贲门狭窄2例(0.97%),均予保守治疗出院。随访时间9~67个月,第3和5年以上病灶复发3和2例,第3和5年总复发率分别为3.53%和4.35%;第3和5年以上死亡各2例,3和5年生存率分别为97.65%(83/85)和95.65%(44/46)。结论 ESD治疗早期胃癌及癌前病变是一种简便、安全、疗效肯定的方法,临床值得推广。     

Diagnosis of simultaneous multiple gastric cancers by the endoscopic Congo red--methylene blue test

The clinicopathological features of simultaneous multiple gastric cancers, and the accuracy of their diagnosis by routine endoscopic examination were analyzed. In addition, the accuracies of diagnosis of coexisting early gastric cancers by routine endoscopic examination and by the endoscopic Congo red--methylene blue test developed in our hospital were compared. The results showed that multiple cancers occurred frequently in elderly male patients, in patients with early gastric cancer of the flat and elevated types and the depressed type without converging folds, and in patients with advanced cancer of Borrmann type I. These patients frequently have early cancers of the flat or depressed types without converging folds, and advanced cancers of Borrmann type I. The coexisting lesions are very difficult to diagnose by routine endoscopic examination: a correct diagnosis of coexisting early cancers was made in only 28.3% of the cases by routine endoscopic examination. But with the Congo red--methylene blue test, the diagnostic rate was raised significantly to 88.9%. In this test, Congo red and methylene blue are sprayed on the surface of the stomach and are bleached within 2 to 5 minutes on the surface of a tumor, but not on the surface of unaffected mucosa.     

Is endoscopic ultrasonography indispensable in assessing the appropriateness of endoscopic resection for gastric cancer?

BACKGROUND AND STUDY AIMS: Endoscopic resection is increasingly being used in the treatment of early gastric cancer. The aim of the present study was to investigate the accuracy of pretherapeutic staging techniques for assessing the appropriateness of endoscopic resection. PATIENTS AND METHODS: Both endoscopy and endosonography were carried out at our institution in the treatment of 234 early gastric cancers, with histological confirmation of malignancy following surgical resection (137 lesions) or endoscopic resection (97 lesions). The accuracy in detecting intramucosal cancer with each of the diagnostic procedures was assessed. RESULTS: The accuracy rates for detecting intramucosal cancer using endoscopy and endosonography were calculated as 84 % (197 of 234) and 78 % (182 of 234), respectively. The accuracy tended to be lower in lesions located in the upper third of the stomach, in those measuring 2 cm or more in diameter, and in those with an undifferentiated histology with ulcer fibrosis. However, there were no significant differences in the accuracy rates between endoscopy and endosonography. Precise staging was achieved by endoscopy alone in 103 of 109 differentiated adenocarcinomas without ulcer fibrosis, where the lesions measured less than 2 cm in diameter. CONCLUSIONS: Endoscopic resection is indicated in intramucosal gastric cancer lesions showing differentiated histology, no ulcer fibrosis and a diameter of less than 2 cm. EUS may additionally be used for further evaluation in these patients.     

高频微探头超声内镜检查在结直肠癌术前TN分期中的价值

目的:探讨高频微探头超声内镜(EUS)检查在结直肠癌TN分期中的价值.方法:145例结直肠癌患者术前采用高频微探头EUS检查进行TN分期,并与术中探查和术后病理检查结果进行比较.结果:结直肠癌患者术前高频微探头EUS检查的T、N分期与术后病理分期符合率分别为84.83％和70.34％,其中T1、T2、T3、T4期的符合率分别为88.89％、85.71％、84.27％和80.00％.对有无淋巴结转移的诊断符合率较高,分别为98.41％(N+)、92.68％ (N0).N1、N2分期的符合率分别为76.92％和16.22％.结论:高频微探头EUS检查能较准确地判断结直肠癌的浸润深度(T分期),尤其适用于早期结直肠癌和癌性狭窄患者的术前分期;对有无淋巴结转移判断较准确,对N分期,尤其N2分期准确性有待提高.     

Diagnosis of gastric inflammation and malignancy in endoscopic biopsies based on Fourier transform infrared spectroscopy

BACKGROUND: Fourier transform infrared (FT-IR) spectroscopy is an effective tool for investigation of chemical changes at the molecular level. We previously demonstrated that FT-IR spectroscopy can reliably distinguish multiple types of carcinoma from healthy tissue. Because various stomach diseases are common, it is important to explore a noninvasive and rapid method to detect malignancy and gastritis in endoscopic biopsies. Our aim was to classify endoscopic biopsies into healthy, gastritis, and malignancy through the use of FT-IR spectroscopy. METHODS: A total of 103 endoscopic samples, including 19 cases of cancer, 35 cases of chronic atrophic gastritis, 29 cases of chronic superficial gastritis, and 20 healthy tissue samples, were obtained at the First Hospital of Xi'an Jiaotong University, China. A modified attenuated total reflectance accessory was linked to a WQD-500 FT-IR spectrometer for biopsy measurement. The spectral characteristics for different types of tissues were correlated with the corresponding pathology results. The gastric biopsies were classified by FT-IR spectroscopy and a discriminant analysis method. RESULTS: There were significant differences in the FT-IR spectra of four types of gastric biopsies. The discriminant analysis results demonstrated that the sensitivity of FT-IR detection for healthy, superficial gastritis, atrophic gastritis, and gastric cancer was 90%, 90%, 66%, 74%, respectively, which could help satisfy clinical diagnostic requirements. CONCLUSION: FT-IR spectroscopy can distinguish disease processes in gastric endoscopic biopsies.