幽门螺杆菌根除后早期胃癌和癌前病变93例内镜特点分析  

Analysis of endoscopic characteristics in 93 cases of early gastric cancer and precancerous lesions after Helicobacter pylori eradication

作　　者：董志霞[1] 夏杰 吴姗 石岩 朱梅影 钱月琴[1] 宛新建[1] Dong Zhixia;Xia Jie;Wu Shan;Shi Yan;Zhu Meiying;Qian Yueqin;Wan Xinjian(Digestive Endoscopic Center,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院消化内镜中心,上海200233

出　　处：《中华消化杂志》2023年第4期268-273,共6页Chinese Journal of Digestion

基　　金：上海市第六人民医院院级临床回顾性研究课题(ynhg202018);上海市消化系统疾病临床医学中心(19MC1910200);上海市青年科技英才扬帆计划(20YF1436300)。

摘　　要：目的探讨幽门螺杆菌(H.pylori)根除后早期胃癌和癌前病变的内镜特点。方法收集2019年5月至2022年6月在上海交通大学附属第六人民医院诊断为分化型早期胃癌和癌前病变患者的病史资料。选择其中既往有H.pylori感染病史,并经过规范根除治疗,符合H.pylori根除后(以下简称除菌后)早期胃癌及癌前病变的病例93例,回顾性分析其内镜特点。统计学方法采用独立样本t检验、卡方检验和Fisher确切概率法。结果93例除菌后早期胃癌和癌前病变的患者中,男性56例,女性37例,年龄为(66.9±8.2)岁。中位H.pylori根除时间(范围)为3.4年(1.0~7.0年)。共发现109个病变,单发病灶患者79例,多发病灶患者14例(30个病灶);早期胃癌组60例(病变73个);癌前病变组33例(病变36个)。93例患者中,内镜下胃黏膜缩范围木村-竹本分类法为闭合型-2及以上分型病例占89例(95.7%)。109个病变长径为(1.38±0.70)cm,短径为(1.04±0.53)cm,80个(73.4%)病变位于下胃1/3,53个(48.6%)病变位于胃小弯侧;106个(97.2%)病变内镜下表现为表浅型(0-Ⅱ型)病变。除菌后早期胃癌组患者病变长径、短径均大于癌前病变组[(1.54±0.78)cm比(1.06±0.35)cm,(1.16±0.58)cm比(0.78±0.33)cm],差异均有统计学意义(t=3.53、3.73,均P<0.001)。除菌后早期胃癌与癌前病变组内镜下大体形态分型差异有统计学意义(χ^(2)=11.01,P=0.012),除菌后早期胃癌内镜下大体形态以浅表凹陷型(0-Ⅱc型)为主,占45.2%(33/73),癌前病变以浅表隆起型(0-Ⅱa型)和浅表平坦型(0-Ⅱb型)为主,均占38.9%(14/36)。结论除菌后早期胃癌和癌前病变的内镜下萎缩范围多为闭合型-2及以上,病变多位于中胃下1/3,长径<20 mm,以表浅型病变尤其是浅表凹陷型病变居多。Objective To analyze the endoscopic characteristics of early gastric cancer and precancerous lesions after Helicobacter pylori(H.pylori)eradication.Methods From May 2019 to June 2022,at Shanghai Sixth People′s Hospital affiliated to Shanghai Jiaotong University School of Medicine,the medical data of patients diagnosed with differentiated early gastric cancer and precancerous lesions were collected.A total of 93 patients with early gastric cancer and precancerous lesions who had previous history of H.pylori infection and had undergone standardized eradication treatment were selected,and their endoscopic characteristics were retrospectively analyzed.Independent sample t-test,chi-square test,and Fisher′s exact test were used for statistical analysis.Results Among 93 patients with early gastric cancer and precancerous lesions after H.pylori eradication,there were 56 males and 37 females,with an average age of(66.9±8.2)years old.The time after H.pylori eradication was 3.4 years(range 1.0 to 7.0 years).A total of 109 early gastric cancer and precancerous lesions were found,including 79 patients with single lesion and 14 patients with multiple lesions(30 lesions).There were 60 cases with 73 lesions in the early gastric cancer group and 33 cases with 36 lesions in the precancerous group.Among 93 patients,89 cases(95.7%)were diagnosed with atrophy level above C-2 according to Kimura-Takemoto classification under endoscopy.The long diameter of 109 lesions was(1.38±0.70)cm and the short diameter was(1.04±0.53)cm.A total of 80 lesions(73.4%)were located in the lower 1/3 part of the stomach,and 53 lesions(48.6%)were located in the lesser curvature.A total of 106 lesions(97.2%)were superficial type(0-Ⅱ)under the endoscopy.The long diameter and short diameter in the early gastric cancer group after H.pylori eradication were both greater than those in the precancerous lesion group((1.54±0.78)cm vs.(1.06±0.35)cm,(1.16±0.58)cm vs.(0.78±0.33)cm),and the differences were statistically significant(t=3.53 and 3.73,both P<

关 键 词：幽门螺杆菌 早期胃癌 癌前病变 幽门螺杆菌既往感染 内镜特点 

分 类 号：R735.2[医药卫生—肿瘤]