早期胃癌的内镜下诊疗5年的单中心调查

发布时间：2018-03-28 12:06

  本文选题：胃癌　切入点：早诊早治　出处：《广东医学》2017年21期

【摘要】：目的为调查近几年南方医科大学南方医院消化内科内镜中心加强早期胃癌(EGC)培训后的EGC检出情况,了解EGC内镜特征及诊疗效果。方法对接受胃镜检查的患者进行筛查,统计胃癌患者例数,将手术病理或虽然未行手术治疗但活检病理和超声内镜诊断为EGC的纳入回顾性分析。结果 (1)从2012年1月至2016年12月,南方医科大学南方医院消化内科内镜中心总共完成97 621例胃镜,检出胃癌1 257例(1.3%),其中EGC检出率为13.4%(168/1 257)。2012年EGC检出率为4.2%,2013年为7.1%,2014年为14.5%,2015年为22.3%,2016年为21.9%。(2)EGC患者中男、女分别为123、45例;年龄(57.4±11.6)岁,50~59岁与60~69岁患者最多,分别占32.1%、29.2%,20~29岁与80~89岁患者最少,分别占1.2%、3.6%。(3)168例患者总共181处EGC病变,中位病变最大径为15(10,24)mm。胃冠状面上,上部、中部、下部分别为22、30、129处;胃水平面上,前壁、后壁、小弯、大弯分别为31、16、109、25处。内镜下病变形态:0-Ⅰ、0-Ⅱa、0-Ⅱb、0-Ⅱc、0-Ⅱa+Ⅱc、0-Ⅱc+Ⅱa分别为9、21、2、121、17、11处。溃疡性EGC占18.8%。(4)与病理组织学对比,普通白光内镜(WLE)诊断符合率为54.7%,色素内镜(CE)符合率为73.2%,放大内镜联合电子染色内镜(M-DCE)符合率为89.4%。三者比较,差异有统计学意义(P0.01)。两两比较CE比WLE诊断符合率高且差异有统计学意义(P0.01),M-DCE比WLE诊断符合率高且差异有统计学意义(P0.01),M-DCE比CE诊断符合率高且差异有统计学意义(P0.01)。(5)168例患者中118例(70.2%)行内镜下切除术,其中108例(91.5%)行ESD,9例(7.6%)行EMR,1例(0.8%)行内镜下黏膜下隧道剥离术(ESTD)联合ESD。ESD组整块切除率95.4%,完全切除率89.8%,术中大出血率为2.8%,迟发性出血率为10.2%,术中穿孔率为5.6%,无迟发性穿孔发生。EMR组整块切除率88.9%,完全切除率88.9%,迟发性出血率11.1%,无术中大量出血、术中穿孔及迟发性穿孔事件发生。结论加强EGC培训可以明显提高EGC的检出率,M-DCE诊断符合率明显高于WLE和CE。与日本相比,我们中心EGC存在差异性,患者更年轻化,胃下部、小弯更常见,内镜下治疗安全有效。
[Abstract]:Objective to investigate the detection of EGC in endoscopy center of Department of Digestive Medicine of Southern Hospital of Southern Medical University in recent years after training early gastric cancer, and to understand the characteristics of EGC endoscopy and the effect of diagnosis and treatment. Methods the patients undergoing gastroscopy were screened. A retrospective analysis of the number of patients with gastric cancer, including biopsy, pathology and endoscopic ultrasound diagnosis of EGC, was included in the study from January 2012 to December 2016. A total of 97 621 cases of gastroscopy were performed in the endoscopy center of the Department of Gastroenterology, Southern Hospital of Southern Medical University, and 1 257 cases of gastric cancer were detected and 1. 3% of them were diagnosed with EGC. The detection rate of EGC was 4. 2% in 2012, 7. 1% in 2013, 14. 5% in 2014, 22. 3% in 2015. In 2016, there were 12335 cases of male and female in 21.9%.(2)EGC patients, and the detectable rate of EGC was 4. 2% in 2012, 7. 1% in 2013, 14. 5% in 2014, 22. 3% in 2015. The patients aged 57.4 卤11.6) were the most in age 50 / 59 and 60 / 69 years old, accounting for the least number of patients aged 32.1 / 29.2 / 2029 and 80 / 89 respectively, accounting for a total of 181 EGC lesions, respectively, with the median diameter of 151024mmm. the maximum diameter of the lesion was 151024mmm. the highest diameter of the lesion was 151024mmm. the upper part, the middle part and the lower part of the stomach were 2230129, respectively; the level of gastric water was at the level of stomach water, and the mean diameter of the lesion was 151024mmm. The anterior wall, posterior wall, small curvature and great bend were 31 1 1610 925, respectively. The pathological changes of the anterior wall, posterior wall, small curvature and great bend were respectively 31 1 010925. The morphology of the lesions under endoscopy was 1: 0- 鈪，

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