【无痛胃镜下早期胃癌诊断和治疗的研究】胃癌早期症状

　　[摘要] 目的 开展无痛胃镜下早期胃癌的诊断和治疗。 方法 选择2011年1月～2012年2月进行无痛胃镜检查，对可疑病变内镜下直视取活检3～5块，经病理确诊为早期胃癌、重度不典型组增生、中度不典型组增生的患者共6例，均采用内镜下黏膜切除术治疗。 结果 无痛内镜技术使患者在整个检查和治疗过程中处于睡眠状态，更加有利于治疗操作，6例中直接圈套器切除5例，透明帽切除1例，均为一次性完全切除，未发现出血、穿孔等并发症，内镜分型隆起型4，其中亚蒂型3个，无蒂型1个，平坦型2个。早期癌2例，重度不典型增生3例，中度不典型增生1例。 结论 采用内镜下治疗早期胃癌治疗具有创伤小、并发症少、恢复快的特点，内镜下治疗已经成为早期胃癌的首选治疗方法。
　　[关键词] 早期胃癌；无痛内镜技术；内镜下黏膜切除术
　　[中图分类号] R735.7 [文献标识码] C [文章编号] 1673-7210（2012）07（a）-0153-02
　　Painless gastroscopy in the diagnosis and treatment of early gastric carcinoma
　　LU Baichun LIU Suxia CAI Fangmei WU Honglian
　　Department of Innner Medicine, Zhangmutou Hospital of Dongguan City, Guangdong Province, Dongguan 523633, China
　　[Abstract] Objective To carry out the diagnosis and treatment of early gastric carcinoma by painless gastroscopy. Methods Attempted to carry out the painless gastroscopy examination from January 2011 to Feruary 2012. Three to five biopsy samples with suspected pathological changes were obtained by endoscopic biopsy under direct vision. Six sample cases were pathologically diagnosed with early gastric carcinoma, severe atypical hyperplasia and moderate atypical hyperplasia. Later on, these six cases were treated by endoscopic mucosal resection. Results By painless endoscopy, doctors were able to carry out treatment operation more efficiently as patients are in a sleep state during the diagnosis and treatment. Five (5 out of 6) sample cases were resected?by snare excision while one (1 out of 6) sample cases was resected by hyaline cap. Surgeries for all of the sample cases were one-time complete resection without complication like bleeding and perforation. Besides, referring to the endoscopic classification, four sample cases were protruding type (3 were wide base type and one was sessile type) and two were flat type. Two cases were early carcinoma, three cases were severe atypical hyperplasia and one case was moderate atypical hyperplasia. Conclusion Endoscopic treatment has become the preferred treatment plan for early gastric carcinoma as it has the advantages of narrow wound, low complication rate and fast recovery.
　　[Key words] Early gastric carcinoma; Painless endoscopy; Endoscopic mucosal resection
　　在我国消化系统肿瘤中，胃癌的发病率和死亡率最高。胃癌死亡率占所有恶性肿瘤死亡的23.02%，居各类癌症死亡的首位。在消化系统恶性肿瘤的死亡患者中，约有半数死于胃癌。因此早期发现、早期诊断、早期治疗是提高胃癌患者存活率的先决条件。早期胃癌是指胃癌病变位于黏膜或黏膜下层，而无论病灶大小和是否有淋巴结转移。早期胃癌临床症状不明显，70%以上可无任何症状，早期胃癌患者一般仅部分有轻度消化不良等症状，如上腹隐痛不适、轻微饱胀、疼痛、恶心、嗳气等很多症状，可以跟其他的胃病相混合，加大了早期胃癌排查的难度。我国早期胃癌的研究起步相对较晚，由于客观条件限制，各地早期胃癌占住院胃癌患者的5%～10%。随着内镜在基层医院的普遍开展及内镜诊疗技术的发展，其为早期胃癌的诊断及治疗提供了有利条件。内镜直视下对目标病灶取材活检，可提高阳性率。提高内镜诊断与治疗水平在我国具有重要意义。基于以上情况笔者开展了无痛胃镜下早期胃癌的诊断和治疗的研究。我院于2011年1月开展该项技术，取得了较好的效果，现报道如下：