胃镜检查前抑酸疗法对胃癌诊断影响的回顾性研究  

Retrospective study on the delays in diagnosis of gastric adenocarcinoma in patients accepting antisecretory therapy prior to the first time gastroscopy

作　　者：李庭赞[1] 陈志坦[1] 徐晓军[1] 孙士其[1] 

机构地区：[1]南京医科大学附属南京第一医院消化科,南京210006

出　　处：《临床内科杂志》2006年第1期27-29,共3页Journal of Clinical Internal Medicine

摘　　要：目的通过对临床病例的分析,研究抑酸疗法对胃癌首次胃镜检查诊断的干扰程度及相应对策。方法实验对象均为经胃镜与病理检查最终证实的胃癌患者,包括胃体腺癌与胃窦腺癌。根据首次电子胃镜检查前抑酸剂的使用情况,分为H2受体阻滞剂(H2RA)治疗组、质子泵抑制剂(PPI)治疗组及未经抑酸治疗的对照组,通过组间比较以探讨抑酸剂的使用与胃癌漏诊率之间的关系。按日本Borrmann分型标准,对各组胃癌的分型构成及漏诊病例的分型构成进行分析,试图找出漏诊的规律。结果H2受体阻滞剂治疗组的漏诊率:胃体腺癌为6.66%(5/75),胃窦腺癌为10.7%(9/84)。质子泵抑制剂治疗组相应的漏诊率为9.37%(6/64)和12.7%(13/102)。而未经抑酸治疗的对照组的相应漏诊率为1.36%(1/73)和2.63%(2/76)。胃体腺癌及胃窦腺癌经过抑酸疗法后,其首次内镜检查漏诊率均高于未经抑酸治疗的对照组,组间比较差异有显著性。通过Borrmann分型发现,漏诊患者均为早期胃癌Ⅱb型、Ⅱc型及进展期胃癌Ⅱ型、Ⅲ型。结论抑酸疗法作为消化系统疾病常用的治疗手段,在胃镜检查前的不恰当应用,对某些胃癌的及时诊断产生负面影响,致使部分患者漏诊,甚至延误治疗。Objectives To ascertain the interference of antisecretory therapy prior to the first time gastroscopy on the diagnosis of the adenocareinoma of the corpus gastricum and antrum gastricum. Methods All outpatients or inpatients with gastric adenocarcinoma confirmed by endoscopy and pathological examination were consecutively observed in Nanjing First Hospital, the relationships between the rate of missed diagnosis and the application of acid suppression prior to the first time gastroscopy were studied, the subtype of each case of gastric adenocarcinoma was determined by Borrmannt criteria. Results In patients taking H2 receptor antagonist,6.67% of the adenocareinoma in the corpus gastricum and I0.7% in the antrum gastricum were misdiagnosed as benign diseases. While in those who taking proton pump inhibitor,the diagnosis of 6 cases of adenocareinoma in the corpus gastricum and 13 cases in the antrum gastricum were delayed,the rates of missed diagnosis were 9.37% and 12.7%. Whereas the rate of missed diagnosis in patients without antisecretory therapy were 1.36% and 2.63% respectively. The rates in the patients taking antisecretory therapy were higher than those in patients without antisecretory therapy, especially in patients taking proton pump inhibitor, the rates of missed diagnosis are much higher than those in control groups with statistical meanings. We also found that most of the misdiagnosis occurred in patients with early stage cancer, type Ⅱ b, Ⅱ c and advanced stage, type Ⅱ , Ⅲ. Conclusions Acid suppression therapy as a very common symptomatic treatment prior to first time gastroscopy will interfere with the diagnosis of the adenocareinoma. It may mask the endoscopic signs and the diagnosis may be delayed.

关 键 词：胃癌 抑酸疗法 H2受体阻滞剂 质子泵抑制剂 

分 类 号：R735.2[医药卫生—肿瘤]