不同年龄胃溃疡内镜及组织学改变的研究

胃溃疡是消化界公认的胃癌前疾病之一。通过内镜能较好的评估胃溃疡性质，这对正确处理和早期诊断胃癌有重要意义。为探讨各年龄组胃溃疡分布、内镜特点与组织学改变关系，我们回顾性分析了678例胃溃疡胃镜与组织学等的情况，报道如下。     

胃癌前疾病500例内镜检查及随访

目的 探讨胃癌前病变的转归以及与胃癌的关系。方法 收集分析1988－1997年我院经胃镜及病理确诊的胃癌前病变患者500例相关资料,进行5－10年的罗镜跟踪随访。结果 （1）胃溃疡组（GU）156例,经治疗总有效率为84.6%,发生癌变4例,检出率为2.6%;(2)慢性萎缩性胃炎组（CAG）300例,经治疗后,好转98例,占32.6%,无变化131例,占43.7%,不同程度加重71例,占23.7%,发生癌变6例,检出率为2％;（3）胃息肉组44例,其中2例为多发性息肉,均发生癌变,占4.5％。结论 确认为胃癌前病变的患者应积极治疗,可提高治愈率,但因种种原因,部分患者可加重,少数可癌变。因此采取长期胃镜跟踪随访是必要的、有效的措施。     

老年人胃溃疡病的临床研究（附14例随访分析）

随着内镜技术的不断发展，溃疡病的诊治水平有了很大的提高，由于老年人胃癌发病率高，胃溃疡又具有一定的癌变率．因而目前老年人胃溃疡病手术治疗较为盛行。老年人手术风险大，术后并发症多，手术经济负担重，而溃疡病内科治疗愈合率几近100％。2年来我们对确诊为胃溃疡的14例老年病人内科治疗并随访，取得满意的疗效。报告如下。     

老年胃溃疡和胃癌超声内镜与胃镜病理诊断对比

胃肠道疾病诊断常依靠胃镜和X线钡餐检查,近年随着超声内镜(EUS)技术的发展和应用,拓宽了胃肠疾病诊断范围,利用EUS检查胃肠疾病也逐渐受到重视。本研究对比EUS与胃镜病理对老年胃溃疡和胃癌的诊断,旨在评价EUS诊断胃溃疡和胃癌的临床价值。     

313例胃溃疡内镜检查与病理分析

１９９３年１月至１９９７年４月 ,我院胃镜检查在２３２０例中检出胃溃疡 (含良恶性 )３１３例 ,全部病例均作活检和病理检查 ,现分析总结如下 :１．材料与方法 :(１)溃疡与年龄性别关系 :３１３例胃溃疡病例中 ,男２２９例 ,女８４例 ,男多于女。年龄最小１６岁 ,最大７６岁。平均４６岁。胃镜检查时 ,均在溃疡灶取材３～１０小块 ,经８０ %乙醇固定 ,常规脱水石蜡包埋切片 ,Ｂ、Ｅ染色 ,光镜检查。(２)根据胃镜下病灶形态特点 ,作出内镜诊断 ,包括良性溃疡、恶性溃疡和疑似恶变 ,最后经病理检查确诊。２．结果与分析 :各年龄组发病情况见…     

Leptin在胃溃疡及胃癌中的表达差异研究

目的：比较Leptin在胃溃疡及胃癌中表达的差异性。方法：分别通过胃镜和手术获得胃溃疡及胃癌的样品标本，用Westem—blot法及免疫组化方法(DAB显色法)分别检测人胃溃疡组织及胃癌组织中Leptin蛋白的表达情况。结果：胃癌组织、癌旁组织、溃疡周边组织中均可测量到Leptin蛋白。免疫组化染色结果显示Leptin在癌组织中和胃溃疡周边黏膜均有表达，在胃癌组织中表达较强。结论：Leptin在胃癌组织中表达高于胃溃疡周边组织，且两者表达有明显差异性，可能与肿瘤的发展有关。     

青年人胃癌40例的临床,内镜及病理分析

４０例青年人胃癌，占同期我院胃镜检出胃癌６９９例的５．７％。男性２６例，女性１４例。３１～３５岁为１５例（３７．５％），最小年龄为１５岁。早期胃癌３例（７．５％），进展期癌３７例。手术切除率为４２．５％。５年生存率为１５％（６／４０）。本组发现５例胃癌与十二指肠溃疡共存。本文分析了青年人胃癌的特点与预后差的主要原因，并讨论了青年人胃癌与胃溃疡关系以及与十二指肠溃疡共存问题。     

胃溃疡癌变的内镜和组织学观察

胃溃疡癌变的内镜和组织学观察苏秉忠高俊珍王泽强邹景林作者从内镜和组织学角度，观察溃疡边缘和邻近粘膜的差异，分析胃溃疡可能的癌变基础。一、材料和方法：本组观察４６３例，分十二指肠溃疡组（ＤＵ）、胃溃疡组（ＧＵ）、溃疡型胃癌组和对照组（非溃疡组）。详细记...     

内镜下注射治疗胃溃疡出血失败的因素分析

内镜下注射治疗（ｅｎｄｏｓｃｏｐｙｉｎｊｅｃｔｉｏｎｔｒｅａｔｍｅｎｔ，ＥＩＴ）是处理消化性溃疡出血安全有效的方法，但仍有继续出血或再出血的可能。确认哪些患者不宜行ＥＩＴ具有重要的临床意义。本文旨在分析ＤＩＴ失败的高危因素。一、病例和治疗：１９９２年７月～１９９７年７月，我们在急诊内镜检查中发现１４６例胃溃疡患者有活动性出血（渗血、涌血或喷血）或新鲜血凝块相关的色素性血管隆起，立即行ＥＩＴ。采用电子胃镜及ＮＭ７Ｌ型注射针。对活动性出血，在血管周围及血管内注射１０～２０ｍｌ１∶１００００的肾上腺…     

胃黏膜上皮细胞异型增生的随访研究

目的：探讨胃黏膜上皮细胞异型增生自然演变的规律及其在胃癌形成中的作用，为临床处理异型增生病灶提供依据和初步方法。方法：回顾性研究16年来50岁以上患者的胃镜检查结果，分析不同程度的异型增生的变化规律和可能的影响因素。结果：4354例患者共检出胃黏膜上皮细胞异型增生239例(261个病灶)，其中轻度异型增生119例(病灶131个)，中度异型增生77例(病灶83个)，重度异型增生43例(病灶47个)。异型增生病灶主要沿胃小弯侧分布。异型增生病灶外观各异，以局灶糜烂为最常见，133个(50．96％)，其次为局部充血50个(19．16％)，溃疡26个(9．96％)，正常黏膜外观24个(9．20％)。进行了完整随访的195例患者，轻度异型增生病变消失率最高，达86．36％，但也有8．18％检出胃癌；重度异型增生癌检出率最高，达72．09％，但也有23．26％发生了逆转，中度异型增生的消失率和癌检出率则居于前两者之间。轻度、中度、重度异型增生中癌检出率的相对危险度分别为1．96、3．74、17.25。结论：不同程度的异型增生均有一定的癌变能力，以重度异型增生的癌变率为最高。对不同程度的异型增生的处理上均要积极，同时也要注意区别对待。     

Long-term follow-up of 2529 patients reveals gastric ulcers rarely become malignant

To examine the relationship between peptic ulcer and gastric cancer, we investigated 2529 patients with peptic ulcer diagnosed from 1963 to 1975. During the follow-up period of 9–23 years, we found 38 in whom gastric cancer developed or who died of gastric cancer. Included were nine in whom gastric cancer was detected at the same site as the gastric ulcer initially diagnosed, and 22 in whom the gastric cancer was detected at another site. In the remaining seven, gastric cancer was given on the death certificate, but the details were unknown. When the data on gastric ulcer initially diagnosed were reevaluated, gastric cancer was suspected or could not be completely ruled out in seven of the nine in whom gastric cancer was detected at the same site. In the remaining two, a diagnosis of benign ulcer was made even when the initial data were reviewed. In these two, however, there was the possibility that the initially diagnosed gastric ulcer represents a phase of the malignant cycle. The number of deaths from gastric cancer in patients with gastric ulcer was significantly low, compared with that expected and computed by the age- and sex-matched general population. These results suggest that gastric ulcers rarely become malignant.     

胃黏膜相关淋巴组织淋巴瘤临床研究及随访

目的探讨胃黏膜相关淋巴组织淋巴瘤的临床特征及治疗策略。方法采用回顾性方法对32例经组织学确诊的胃黏膜相关淋巴组织淋巴瘤进行随访。结果32例患者中多数起病隐匿，上腹痛为主要症状，也有以消化道出血入院者。内镜下病变主要分布在胃窦部，以隆起型和溃疡型表现为主。首次胃镜检查约25％获正确诊断。本组病例幽门螺杆菌感染率约为88％。20例（62．5％）接受了手术治疗，15例（46．88％）行幽门螺杆菌根除治疗，其中，3例早期阶段患者获得组织学完全缓解。结论胃黏膜相关淋巴组织淋巴瘤的临床表现、内镜下特征和病理特点的认识有待进一步提高。对早期阶段患者幽门螺杆菌治疗当属首选。     

A case of hypereosinophilic syndrome presenting with intractable gastric ulcers

We report a rare case of hypereosinophilic syndrome (HES) presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacter pylori (H pylori ) eradication therapy followed by proton pump inhibitor (PPI) therapy. However, followup endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% (total count: 7903/mm3). Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylori eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered.     

Endoscopic follow-up after colorectal cancer resection: An Italian multicentre study

BACKGROUND: Endoscopic follow-up is advised in patients operated for colorectal cancer due to a high risk for both metachronous colorectal cancer and adenomas. Such issue has been scarcely addressed in Italy. This study aimed to evaluate the incidence of neoplastic lesions at a scheduled endoscopic follow-up and to identify the patients at higher risk of recurrence. METHODS: Colorectal cancer patients diagnosed in the three participating hospitals (one North, one Centre and one South Italy) were scheduled for colonoscopies at 1, 3 and 5 years after surgery. Incidence of adenomas, advanced adenomas and colorectal cancer was assessed in all patients. Neoplastic incidence in patients with and without synchronous lesions at entry was also compared. RESULTS: Overall, 318 consecutive patients were prospectively enrolled including 108 (34%, group A) with a synchronous lesion and 210 (group B) without it. A cumulative neoplastic incidence of 20.1, 32.4 and 44% was observed at 1, 3 and 5 years of follow-up, respectively. The cumulative incidence of all the lesions was 70% in group A and 30.2% in group B at 5-year follow-up, being 39.5 and 15.5% after excluding the lesions detected at 1-year examination. A neoplastic lesion was detected more frequently in group A at 1year (30.5% versus 14.7%; p = 0.0013), 3 years (21.4% versus 7.6%; p = 0.0008) and at 5years (18.1% versus 7.8%; p = 0.02). CONCLUSIONS: Our data showed that the incidence of adenomas in patients operated for colorectal cancer is fairly high. Colorectal cancer patients with synchronous lesions are at higher risk of neoplastic recurrence at follow-up as compared to those without them.     

内镜超声检查诊断胃原发性淋巴瘤的临床价值

目的 探讨EUS对胃原发性淋巴瘤(PGL)诊断、鉴别诊断及随访的临床价值.方法 对26例内镜形态学高度可疑为PGL的患者进行EUS探查,并根据其影像特征对病变性质做出判断,将EUS判断与常规内镜活检及常规内镜活检结合EUS指导大块活检结果进行比较分析.结果 与活检及手术病理组织学对照,EUS正确判断23例,2例PGL误诊为胃癌,1例胃癌误诊为PGL.EUS诊断符合率明显高于常规内镜活检(88.5%比50.0%,P=0.006),而略低于常规内镜活检结合EUS指导大块活检(92.3%,P=1.000),EUS对胃恶性病变与炎性巨大胃黏膜皱襞的鉴别诊断符合率达100.0%.EUS对浸润深度(T分期)的判断准确率为100.0%(12/12).结论 EUS可有效鉴别PGL及其他胃内溃疡或增殖性病变,对其治疗、随访具有重要作用.     

Gastric cancer among peptic ulcer patients: Retrospective, long-term follow-up

BACKGROUND: Patients with duodenal ulcer are not at high risk although Helicobacter pylori infection is no doubt associated with gastric cancer development. However, little is known about the risk after long-term follow-up. AIMS: We investigated the incidence for gastric cancer development in peptic ulcer patients in a long term. PATIENTS AND METHODS: Between 1965 and 2004, endoscopic follow-up of more than 1 year was conducted on 1504 peptic ulcer patients in our hospital. They consisted of 978 gastric ulcer patients, 444 duodenal ulcer patients and 82 gastric and duodenal ulcer patients. Gastric and duodenal ulcer patients were excluded from the analysis because of their limited number. RESULTS: Gastric cancers developed in 32 (3.3%) of gastric ulcer patients and 3 (0.68%) of duodenal ulcer patients. Kaplan-Meier analysis showed that the incidence of gastric cancer in duodenal ulcer patients was significantly lower than that in gastric ulcer patients (log-rank test, p=0.0059). Cox's proportional hazard model denoted the relative risk for duodenal ulcer against gastric ulcer adjusted by sex and age as 0.23 (95% CI: 0.072-0.77, p=0.016). CONCLUSION: The risk for patients with duodenal ulcer to develop gastric cancer over the long term is significantly less than in those with gastric ulcer.     

Severity of gastric mucosal atrophy affects the healing speed of post-endoscopic submucosal dissection ulcers

AIM To investigate factors associated with the healing of endoscopic submucosal dissection(ESD)-induced ulcers.METHODS We enrolled 132 patients with gastric tumors scheduled for ESD. Following ESD, patients were treated with daily lansoprazole 30 mg or vonoprazan 20 mg. Ulcer size was endoscopically measured on the day after ESD and at 4 and 8 wk. The gastric mucosa was endoscopically graded according to the Kyoto gastritis scoring system. We assessed the number of patients with and without a 90% reduction in ulcer area at 4 wk post-ESD and scar formation at 8 wk, and looked for risk factors for slower healing.RESULTS The mean size of gastric tumors and post-ESD ulcers was 17.4 ± 12.1 mm and 32.9 ± 13.0 mm. The meanreduction rates in ulcer area were 90.4% ± 0.8% at 4 wk and 99.8% ± 0.1% at 8 wk. The reduction rate was associated with the Kyoto grade of gastric atrophy at 4 wk(A0: 97.9% ± 0.6%, A1: 93.4% ± 4.1%, and A2: 89.7% ± 1.0%, respectively). In multivariate analysis, the factor predicting 90% reduction at 4 wk was gastric atrophy(Odds ratio: 5.678, 95%CI: 1.190-27.085, P = 0.029).CONCLUSION The healing speed of post-ESD ulcers was associated with the degree of gastric mucosal atrophy, and Helicobacter pylori eradication therapy is required to perform at younger age.     

Use of lectin microarray to differentiate gastric cancer from gastric ulcer

AIM:To investigate the feasibility of lectin microarray for differentiating gastric cancer from gastric ulcer.METHODS:Twenty cases of human gastric cancer tissue and 20 cases of human gastric ulcer tissue were collected and processed.Protein was extracted from the frozen tissues and stored.The lectins were dissolved in buffer,and the sugar-binding specificities of lectins and the layout of the lectin microarray were summarized.The median of the effective data points for each lectin was globally normalized to the sum of medians of all effective data points for each lectin in one block.Formalin-fixed paraffin-embedded gastric cancer tissues and their corresponding gastric ulcer tissues were subjected to Ag retrieval.Biotinylated lectin was used as the primary antibody and HRP-streptavidin as the secondary antibody.The glycopatterns of glycoprotein in gastric cancer and gastric ulcer specimens were determined by lectin microarray,and then validated by lectin histochemistry.Data are presented as mean±SD for the indicated number of independent experiments.RESULTS:The glycosylation level of gastric cancer was significantly higher than that in ulcer.In gastric cancer,most of the lectin binders showed positive signals and the intensity of the signals was stronger,whereas the opposite was the case for ulcers.Significant differences in the pathological score of the two lectins were apparent between ulcer and gastric cancer tissues using the same lectin.For MPL and VVA,all types of gastric cancer detected showed stronger staining and a higher positive rate in comparison with ulcer,especially in the case of signet ring cell carcinoma and intra-mucosal carcinoma.GalNAc bound to MPL showed a significant increase.A statistically significant association between MPL and gastric cancer was observed.As with MPL,there were significant differences in VVA staining between gastric cancer and ulcer.CONCLUSION:Lectin microarray can differentiate the different glycopatterns in gastric cancer and gastric ulcer,and the lectins MPL and VVA can be used as biomarkers.