提高早期胃癌诊断的初步探讨

目的：探讨如何提高对早期胃癌的诊断率。方法：回顾性分析了1996年－1998年间9509例胃镜检查及2278例病理活检资料，结合手术记录。结果：有症状患者胃癌的检出率为6．77％（644／9509例），其中≥40岁者（9．97％）明显高于＜40岁者（1．08％）（P＜0．01）男性高于女性（P＜0．01）。病理活检中胃癌的检出率达28．27％（644／2278例），胃癌及癌前病变的病理检出总的阳性率高达70．85％（1614／2278例），其中＜40岁患者的阳性率为43．47％，而≥40岁者则高达75．86％（P＜0．01）。胃癌及癌前病变的平均年龄均高于炎症组（P＜0．01）。胃癌高发年龄为50－69岁之间，占68．2％。各病变中男性均多于女性，但40岁以前胃癌中女性多于男性(P＜0．05）。胃体及贲门部位的恶性病变多于良性病变（P＜0．01）。结论：40岁以上有症状者应常规行胃镜检查，尤其是50岁以上男性有癌前病变者以及胃体、贲门部位病变应常规行胃镜下病理活检，以及定理复查胃镜。

Evaluation of Enhancing Diagnostic Rate in Early Cancer

The aim of this study was to enhance the diagnostic rate in early gastric cancer. Methods: 9 509 cases gastroscopy and 2 278 cases histopathology combining with the operation between 1996 and 1998 were analyzed retrospectively. Results: The detected rate of gastric cancer in the symptomatic patients is 6.77% (664/9509 cases), and the patients no younger than 40(9.97% ) is more than that younger then 40( 1.08 % )(P ＜ 0.01), in which the male (8.42 % ) is more higher than the female (4.49 % ) (P ＜ 0.01 ). The detected rate of histopathology in gastric cancer is 28.27 % (644/2278 cases). The total positive rate of histopathology (include gastric cancer and premalignant lesions) is 70.85 % (1614/ .2278cases), in which, the positive rate of patients in age of less than 40 is 43.47%, but that in age of no less than 40 is 75.86% (P＜0.01). The mean ages of patients with gastric cancer and premalignant lesions were older than that of patients with inflammation respectively (P ＜ 0.01). The peak incidence was in patients 50～69 years of age and accounted for 68.2%. The male is more than female in all lesions, but in patients with gastric cancer in age of less than 40, the female is more than the male (P ＜0.05). Malignant lesions in gastric body and cardia were more than benign lesion(P ＜0.01). Conclusion: The patients in age of more than 40 should be taken gastroscopy co mmonly, especially the male in age of more than 50, and with pre-malignant lesions and the lesions in gastric body and cardia must be taken histopathology under gastroscope and follow up regularly.