早期胃癌检出情况及其内镜下特征分析(附43例报道)*
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周建波,E-mail:cszlm2010@163.com

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*基金项目:余姚市科技计划(No:2016YPT04);宁波市医学科技计划(No:2016A51)


Detection of early gastric cancer and analysis of its endoscopic characteristics (43 cases)*
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    调查分析浙江省余姚地区早期胃癌(EGC)的检出情况,探讨EGC内镜下特点及病理学特征。方法 回顾性收集2016年度宁波大学医学院附属阳明医院消化内镜中心行胃镜检查患者的病例资料,筛选统计出EGC(检查时发现并经病理确诊)的检出率,并对发现的43例EGC患者(47处病灶)的临床资料进行回顾性总结,对比分析其普通白光内镜下特征、窄带成像(NBI)放大内镜下特征及病理学特征。结果 EGC的总体检出率为0.23%(43/18 534),占胃癌总检出例数的24.71%(43/174)。本研究发现EGC以发生在胃窦部最常见(36.17%,17/47),病灶大小以>1.0 cm为主(68.09%,32/47),内镜下形态以0-Ⅱc型病灶为主,占55.32%(26/47)。白光内镜下表现为黏膜发红35处(74.47%,35/47)、边界清晰43处(91.49%,43/47)、表面不规则42处(89.36%,42/47)、黏膜萎缩和(或)肠上皮化生39处(82.98%,39/47)、边缘毛刺状17处(36.17%,17/47)、白色不透明物质(WOS) 8处(17.02%,8/47)、表面溃疡13处(27.66%,13/47),自发性出血21处(44.68%,21/47)。30处病灶行NBI放大内镜检查,病灶边界线清晰占86.67%(26/30),病灶黏膜下微血管不规则或消失占96.67%(29/30),病灶上皮微细结构和腺管开口不规则或消失占90.00%(27/30)。病理分型以分化型为主(89.36%,42/47)。结论 EGC多见于胃窦部,形态以0-Ⅱc型为主,在白光内镜下注意观察胃黏膜局部色调的改变及特征,以及NBI放大内镜下病灶边界、黏膜下微血管及上皮微细结构和腺管开口的变化,有助于提高EGC的诊断率。

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    Abstract: Objective To investigate and analyze the detection of early gastric cancer (ECG) and explore the endoscopic and pathological characteristics. Methods Clinical data of patients underwent gastroscopy in 2016 were retrospectively collected for the screening and statistics of the detection rate of ECG (detected in examination and confirmed by pathology). In addition, the clinical data of 43 detected patients with ECG (47 lesions) were retrospectively summarized. Endoscopic characteristics under a white light endoscope and a magnifying endoscope with narrow band imaging (NBI) as well as pathological characteristics of ECG were compared. Results The overall detection rate of ECG was 0.23% (43/18,534), accounting for 24.71% (43/174) in the total detected cases of gastric cancer. This study revealed that ECG was the most commonly detected in the gastric antrum (36.17%, 17/47), lesion size >1.0 cm was the most common (68.09%, 32/47), and 0-iic type were the most common under the endoscope, accounting for 55.32% (26/47). Under the white light endoscope, 35 (74.47%, 35/47) lesions showed mucosal redness, 43 (91.49%, 43/47) lesions presented clear boundaries, 42 (89.36%, 42/47) lesions exhibited irregular surface, 39 (82.98%, 39/47) lesions demonstrated mucosal atrophy and (or) intestinal metaplasia, 17 (36.17%, 17/47) lesions presented edge burrs, 8 (17.02%, 8/47) lesions showed WOS, 13 (27.66%, 13/47) lesions had superficial ulcers, and 21 (44.68%, 21/47) lesions demonstrated spontaneous bleeding. Magnifying endoscopy with NBI was conducted in 30 lesions, revealing clear boundaries in 86.67% (26/30) lesions, irregular or disappeared submucosal microvasculature in 96.67% (29/30) lesions, and irregular or disappeared epithelial microstructure and pit pattern in 90.00% (27/30) lesions. Differentiated pathological type was dominant (89.36%, 42/47). Conclusion  ECG mainly occurs in the gastric antrum and 0-iic type are dominant. Careful observation of the changes and characteristics of the local tone of gastric mucosa under a white light endoscope as well as the changes in lesion boundaries, submucosal microvasculature, epithelial microstructure and pit pattern under a magnifying endoscope with NBI is helpful to improve the diagnosis rate of ECG.

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蔡升,周建波,桑建忠,宋奇峰,杨倩倩,黄戬,周琴.早期胃癌检出情况及其内镜下特征分析(附43例报道)*[J].中国内镜杂志,2018,24(3):94-99

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  • 收稿日期:2017-08-04
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  • 在线发布日期: 2018-03-31
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