發(fā)布時(shí)間：2018-03-28 12:06

  本文選題：胃癌　切入點(diǎn)：早診早治　出處：《廣東醫(yī)學(xué)》2017年21期

【摘要】：目的為調(diào)查近幾年南方醫(yī)科大學(xué)南方醫(yī)院消化內(nèi)科內(nèi)鏡中心加強(qiáng)早期胃癌(EGC)培訓(xùn)后的EGC檢出情況,了解EGC內(nèi)鏡特征及診療效果。方法對(duì)接受胃鏡檢查的患者進(jìn)行篩查,統(tǒng)計(jì)胃癌患者例數(shù),將手術(shù)病理或雖然未行手術(shù)治療但活檢病理和超聲內(nèi)鏡診斷為EGC的納入回顧性分析。結(jié)果 (1)從2012年1月至2016年12月,南方醫(yī)科大學(xué)南方醫(yī)院消化內(nèi)科內(nèi)鏡中心總共完成97 621例胃鏡,檢出胃癌1 257例(1.3%),其中EGC檢出率為13.4%(168/1 257)。2012年EGC檢出率為4.2%,2013年為7.1%,2014年為14.5%,2015年為22.3%,2016年為21.9%。(2)EGC患者中男、女分別為123、45例;年齡(57.4±11.6)歲,50~59歲與60~69歲患者最多,分別占32.1%、29.2%,20~29歲與80~89歲患者最少,分別占1.2%、3.6%。(3)168例患者總共181處EGC病變,中位病變最大徑為15(10,24)mm。胃冠狀面上,上部、中部、下部分別為22、30、129處;胃水平面上,前壁、后壁、小彎、大彎分別為31、16、109、25處。內(nèi)鏡下病變形態(tài):0-Ⅰ、0-Ⅱa、0-Ⅱb、0-Ⅱc、0-Ⅱa+Ⅱc、0-Ⅱc+Ⅱa分別為9、21、2、121、17、11處。潰瘍性EGC占18.8%。(4)與病理組織學(xué)對(duì)比,普通白光內(nèi)鏡(WLE)診斷符合率為54.7%,色素內(nèi)鏡(CE)符合率為73.2%,放大內(nèi)鏡聯(lián)合電子染色內(nèi)鏡(M-DCE)符合率為89.4%。三者比較,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。兩兩比較CE比WLE診斷符合率高且差異有統(tǒng)計(jì)學(xué)意義(P0.01),M-DCE比WLE診斷符合率高且差異有統(tǒng)計(jì)學(xué)意義(P0.01),M-DCE比CE診斷符合率高且差異有統(tǒng)計(jì)學(xué)意義(P0.01)。(5)168例患者中118例(70.2%)行內(nèi)鏡下切除術(shù),其中108例(91.5%)行ESD,9例(7.6%)行EMR,1例(0.8%)行內(nèi)鏡下黏膜下隧道剝離術(shù)(ESTD)聯(lián)合ESD。ESD組整塊切除率95.4%,完全切除率89.8%,術(shù)中大出血率為2.8%,遲發(fā)性出血率為10.2%,術(shù)中穿孔率為5.6%,無遲發(fā)性穿孔發(fā)生。EMR組整塊切除率88.9%,完全切除率88.9%,遲發(fā)性出血率11.1%,無術(shù)中大量出血、術(shù)中穿孔及遲發(fā)性穿孔事件發(fā)生。結(jié)論加強(qiáng)EGC培訓(xùn)可以明顯提高EGC的檢出率,M-DCE診斷符合率明顯高于WLE和CE。與日本相比,我們中心EGC存在差異性,患者更年輕化,胃下部、小彎更常見,內(nèi)鏡下治療安全有效。
[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 鹵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，

本文編號(hào)：1676256