提高早期胃癌手术率16年临床经验总结  

A summary of 16-year clinical experience in improving the surgical proportion of early gastric cancer

作　　者：朱燕华[1] 吴云林[1] 程时丹[1] 吴巍[1] 李晨[1] 郭滟[2] 蔚青[2] 胡伟国[3] 燕敏[3] 

机构地区：[1]上海交通大学医学院附属瑞金医院消化内科,上海200025 [2]上海交通大学医学院附属瑞金医院病理科,上海200025 [3]上海交通大学医学院附属瑞金医院外科,上海200025

出　　处：《中华消化内镜杂志》2013年第8期441-445,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价胃癌学科群的建立是否能提高早期胃癌的手术率。方法回顾性分析1996年1月至2011年12月的16年问瑞金医院胃癌切除术施行情况，比较2005年胃癌学科群建立前后早期胃癌手术率的变化情况。同时对2005年胃癌学科群建立后7年问早期胃癌手术后病理按巴黎浅表胃肠肿瘤形态学分型标准进行分类，分析早期胃癌形态分型特点与淋巴结转移情况。结果16年间瑞金医院共施行胃癌切除术6026例，其中经术后病理证实的早期胃癌985例，每年的早期胃癌手术率在6．08％～22．45％，平均为16．35％。2005年胃癌学科群成立后，平均每年早期胃癌手术率（19．64％，751／3823）较胃癌学科群成立前（10．62％，234／2203）显著增高，差异有统计学意义（Y。=83．2026，P〈0．0001），且每年的早期胃癌手术率最高达22．45％（154／686）。对学科群后建立后7年间共751例早期胃癌进行形态分型，其中凹陷型早期胃癌共计588例，占全组的78．30％；751例早期胃癌平均淋巴结转移率为12．92％（97／751），不同形态分型问的淋巴结转移率比较差异有统计学意义（，=52．1951，P〈0．0001），其中0一Ⅲ型早期胃癌的淋巴结转移率最高，达31．71％（39／123）。结论早期胃癌手术率的提高有赖于多学科的协作，内镜医师需加强对早期胃癌内镜下形态的认识，提高对凹陷性病灶的鉴别能力。Objective To seek efficient methods for diagnosing early gastric cancer by analyzing the trend of surgical proportion of early gastric cancer in Ruijin Hospital Affiliated to Shanghai Jiaotong University within the recent 16 years. Methods All the gastric cancer patients who received gastrectomy in Ruijin Hospital from January 1996 to December 2011 were involved. The cases of surgery-proven early gastric canc- ers were selected to calculate the annual proportion and to analyze the relation between morphology and lym- phatic metastasis. Results Nine hundred and eighty-five out of 6026 cases who underwent gastrectomy in the recent 16 years were proved to be early gastric cancers by pathology. The annual surgical proportion fluc- tuated from 6. 08% to 22.45% with the average of 16. 35%. The establishment of the multi-disciplinary col- laboration in diagnosis and treatment of gastrointestinal tumors in 2005 was seen as a markstone, after which the annual surgical proportion was greatly increased （19.64%, 751/3823 ） than before （10.62%, 234/2203 ） and hit a historical peak at 22.45% in 2011 （154/686）. The difference was statistically signifi- cant （X2 --83. 2026,P 〈 0. 0001 ）. There were 751 cases of early gastric cancers confirmed during the 7 years after the establishment of collaboration, of which the depressed type of lesions were the most commonly observed （588/751,78.30%）. The rates of lymphatic metastasis were different among all the morphological classifications （X2 = 52. 1951 ,P 〈 0. 0001 ）with the average of 12. 92% （97/751）. The highest lymphatic metastasis rate was observed in the O-III type of early gastric cancer as 31.71% （ 39/123 ）. Conclusion The establishment of multi-disciplinary collaboration was of great value in the diagnosis of early gastric cancer. More attention should be paid to the endoscopic detection, especially to the depressed type of lesions.

关 键 词：早期胃癌 临床诊断 手术率 

分 类 号：R735.2[医药卫生—肿瘤]