青年胃癌外科治疗及病理诊断的规范性分析

目的：比较温州地区青年胃癌外科治疗及病理诊断与2011卫生部发布的胃癌诊疗规范之间的差距，从而规范临床实践，提高胃癌治疗质量。方法调查研究2006-2011年在温州地区部分三甲医院行手术治疗的年龄≤40岁的青年胃癌患者的临床资料，设计临床资料调查表，对患者术前检查、外科治疗、肿瘤病理报告等资料进行收集及分析，并对2006年组和2011年组的资料进行比较。结果共189例青年胃癌患者，肿瘤标志物的总检测例数156例（82.5%），总阳性例数51例（32.7%），165例（87.3%）患者进行了全腹CT增强加平扫检查，行根治手术153例（81.0%）。在术后病理报告中，对肿瘤大小进行描述的117例（61.9%），行R0切除176例（93.1%），被评估的淋巴结组数中位值为8，行根治术的患者中被评估的淋巴结数≥15个共132例（86.3%）。2006年和2011年两组患者检测项目比较均无统计学差异。结论与2011年的胃癌诊疗规范相比，外科治疗和病理诊断仍存在着许多不足，包括不能充分利用肿瘤标志物进行胃癌筛查，影像学检查欠全面，淋巴结清扫与评估不符，病理报告不完整，在一定程度上给胃癌患者的治疗和预后带来不利的影响，因此，临床实践与规范接轨迫在眉睫。

A survey and analysis of surgical treatment and pathological diagnosis among young patients with gastric cancer

Objective To assess the current status of surgical treatment and pathological diagnosis of young patients with gastric cancer with reference of Ministry of Health＆#39;s Guideline of Treatment and Diagnosis for Gastric Cancer （2011）. Methods Clinical and pathological data of 189 patients aged≤40y with gastric cancer in Wenzhou from January 2006 to December 2011 were analyzed retrospectively.The questionnaire was designed with items of preoperative diagnostic procedures, surgical treat-ment, pathological features. Results The measurement of tumor marker was performed in 156 patient（82.5%） with a positive rate of 32.7%（51/156）;165（87.3%） patients had a full abdominal enhanced CT examination and 153 cases received radical surgery（81.0%）. In 117 cases （62.9%） the pathological reports described the tumor size and 176 （93.1%） patients achieved R0 resection. In patients undergoing lymph node dissection, 132 cases（86.3%） had more than 15 lymph nodes assessed and the median of assessed lymph nodes were 8. There were no significant differences in assessed items between 2006 and 2011 groups. Conclusion There are stil many deficiencies in clinical practice compared with 2011 Guideline in treatment and diagnosis for gastric cancer. Therefore the current status of diagnosis and treatment need to be improved and standardized with the reference of 2011 Guideline.