早期胃癌52例内镜诊治分析  

Clinical analysis of endoscopic diagnosis for 52 cases of early gastric cancer

作　　者：刘素丽[1] 张建生[1] 王鼎鑫[1] 焦洋[1] 张月寒[1] 

机构地区：[1]河北省人民医院内镜诊疗科,河北石家庄050051

出　　处：《中国内镜杂志》2012年第2期160-162,共3页China Journal of Endoscopy

摘　　要：目的探讨早期胃癌内镜诊断方法的有效性及临床应用价值。方法回顾性分析52例早期胃癌内镜下表现及窄带成像技术(NBI)、靛胭脂染色后病变及周边组织表现特征,对放大模式下病变黏膜微细形态分型并观察微血管形态,于病变处取活检行组织病理学检查,部分经超声内镜检查后行大片黏膜切除术,并将整块标本再送病理检查,结合病理结果评价内镜下早期胃癌各种诊断方法的可靠性。结果 52例早期胃癌胃镜下表现各不相同,其中Ⅰ型16例,Ⅱa型14例、Ⅱb型5例、Ⅱc型10例,Ⅲ型7例;65.4%位于胃窦部(34/52)、15.4%位于胃角(8/52)、11.5%位于窦体交界(6/52)、7.7%位于贲门及贲门下(4/52)。靛胭脂及NBI染色在放大模式下根据腺管开口形态诊断早期胃癌符合率分别为88.46%(46/52)、71.15%(37/52),两者比较差异有显著性,P<0.05;而病变黏膜微血管形态NBI染色明显优于靛胭脂。结论内镜不同诊断方法联合应用可提高早期胃癌诊断率,指导内镜活检的准确性,在临床有较大的应用价值。[ Objective ] To investigate the efficacy and clinical values of endoscopy in diagnosis of early gastric cancer （EGC）. [Methods] 52 cases of EGC had been detected by conventional endoscopic examination, suspicious lesions were treated with narrow band imaging （NBI） and indigo-carmine-chromoendoscopy respectively, and the medical imaging characteristics were analyzed, meanwhile the surface pattern classification and eapiUary appearance were observed by endoscopy in zoomed mode, then endoscopic biopsy were taken for histopathologieal examination. Among all the patients treated with endoscopic mucosal resection （EMR） after they were checked by endoscopic ultrasonography （EUS）, ca-bloc resection of larger lesions were taken for pathology diagnosis. [ Results ] There were different images under endoscope in all the 52 patients, among which 16 cases were type I , 14 cases were type Ila, 5 cases were type IIb, 10 cases were type Ilc, and other 7 cases were type III. 65.4% （34/52） of the tumors were located in the antrum, 15.4% （6/52） of the tumors were located in the angulus, 11.5% （6/52） of the tumors were located in borderline between the antrum and the angulus, 7.7% （4/52） of the tumors were located in cardiac orifice. Structure of mucosal pit pattern were observed by endoscopy in zoomed mode, the diagnostic accordance rate were 71.15% and 88.46% respectively, there was significant difference in the diagnostic accuracy between the two methods, P 〈0.05. But NBI showed the changes of mierangium clearly, which was helpful for the diagnosis of early gastric cancer. [ Conclusion ] Combining every endoscopic methods of diagnosis of early gastric cancer is useful to improve the accordance rate and the accuracy of biopsy, and therefore it has a great value in clinical application.

关 键 词：内镜 早期胃癌 窄带成像技术 靛胭脂染色 放大内镜 

分 类 号：R735.2[医药卫生—肿瘤]