青年胃癌与老年胃癌临床、内镜、病理特点分析  

Clinicopathological and endoscopic characteristics of gastric carcinoma in young and elderly patients:a comparative study

作　　者：王洪波[1] 宋素贞[2] 周成军[1] 王莉[1] 许伟华[1] 刘斌[1] 郭建强[1] 

机构地区：[1]山东大学第二医院消化科,济南250033 [2]山东中医药大学诊断教研室,济南250355

出　　处：《山东大学学报（医学版）》2009年第10期83-85,90,共4页Journal of Shandong University:Health Sciences

摘　　要：目的对青年与老年胃癌病例的临床、病理及内镜特点进行比较,以指导临床诊断及治疗。方法对48例青年胃癌(≤40岁)和99例老年胃癌(≥65岁)的临床、病理资料进行回顾性比较分析。结果青年组男女比例为1∶1.08,老年组为3.6∶1;青年组与老年组有肿瘤家族史者分别为15例(37.5%)及12例(16.7%),差异有统计学意义(P<0.05);两组肿瘤发生部位均以远端胃为主,而老年组胃底、贲门部明显增多,占14.3%,与青年组相比差异有统计学意义(P<0.05);进展期胃癌Borrmann分型均以Ⅲ型居多,但两组Ⅲ型、Ⅳ型总和所占比例差异有统计学意义(P<0.05);两组幽门螺杆菌感染率无统计学意义(P>0.05);青年胃癌组织学以低分化腺癌、黏液腺癌、印戒细胞癌和未分化癌为主(72.9%),Lauren分型以弥漫型为主,较老年组分化程度更差,恶性度高;钡餐检查较胃镜检查更易误诊青年胃癌(P<0.05);11例早期胃癌5年生存率为100%。进展期胃癌根治术后两组生存率差异无统计学意义(P>0.05),中位生存期青年组(28.2个月,95%CI19.8～41.3)较老年组(26.7个月,95%CI21.0～39.8)略长,但差异无统计学意义(P>0.05)。结论青年胃癌较老年有更明显遗传倾向。病理组织学分化程度差,多为弥漫型。若能行根治手术,与老年胃癌预后无统计学差异。Objective To explore the potential differences in endoscopic and clinicopathological factors between the young and elderly population with gastric cancer（GC）.Methods In young patients（≤40 years,n=48）and elderly patients（≥65 years,n=99）with GC,the clinicopathological findings were compared according to clinical manifestations,gender,hereditary tendency,tumor location,histological type,growth type,prevalence of helicobacter pylori,and survival rates.Results In the young and elderly groups,the male to female ratio was 1∶1.08 and 3.3∶1,respectively.15 young patients and 12 elderly patients had a family history of tumors（P〈0.05）.Most tumors were found at the lower part of the stomach in both groups,but the tumors located at the upper part were more common in the elderly group than in the young group（P 0.05）.General type in both groups was Borrmann Ⅲ type,but the sum of the Borrmann Ⅲ type and Ⅳ type was statistically different（P〈0.05）.As compared with the elderly patients,young patients had worse differentiation and growth type.Prevalence of helicobacter pylori infection in both groups were not significantly different（P〈0.05）.Compared to endoscopy,Barium X-ray had a higher misdiagnosis rate（P〈0.05）.The 5-year survival rate of 11 patients with early GC was100%,and the 1,3,5-year survival rates of young and elderly patients with advanced GC after radical gastroectomy did not statistically differ（P〈0.05）.The median survival time of patients was not significantly longer in young patients（28.2months 95%CI 19.8～41.3）than elderly（26.7months,95%CI 21.0～39.8）patients（P〈0.05）.Conclusion Young patients with GC have a more obvious hereditary tendency than elderly patients,but they have a poorer pathological behavior than elderly patients.The prognosis of the young was similar to of the elderly after radical gastroectomy.

关 键 词：胃肿瘤 病理 胃镜 幽门螺杆菌 

分 类 号：R735.2[医药卫生—肿瘤]