CAJ | 학술논문

目的：比较温州地区青年胃癌外科治疗及病理诊断与2011卫生部发布的胃癌诊疗规范之间的差距，从而规范临床实践，提高胃癌治疗质量。方法调查研究2006-2011年在温州地区部分三甲医院行手术治疗的年龄≤40岁的青年胃癌患者的临床资料，设计临床资料调查表，对患者术前检查、外科治疗、肿瘤病理报告等资料进行收集及分析，并对2006年组和2011年组的资料进行比较。结果共189例青年胃癌患者，肿瘤标志物的总检测例数156例（82.5%），总阳性例数51例（32.7%），165例（87.3%）患者进行了全腹CT增强加平扫检查，行根治手术153例（81.0%）。在术后病理报告中，对肿瘤大小进行描述的117例（61.9%），行R0切除176例（93.1%），被评估的淋巴结组数中位值为8，行根治术的患者中被评估的淋巴结数≥15个共132例（86.3%）。2006年和2011年两组患者检测项目比较均无统计学差异。结论与2011年的胃癌诊疗规范相比，外科治疗和病理诊断仍存在着许多不足，包括不能充分利用肿瘤标志物进行胃癌筛查，影像学检查欠全面，淋巴结清扫与评估不符，病理报告不完整，在一定程度上给胃癌患者的治疗和预后带来不利的影响，因此，临床实践与规范接轨迫在眉睫。
목적：비교온주지구청년위암외과치료급병리진단여2011위생부발포적위암진료규범지간적차거，종이규범림상실천，제고위암치료질량。방법조사연구2006-2011년재온주지구부분삼갑의원행수술치료적년령≤40세적청년위암환자적림상자료，설계림상자료조사표，대환자술전검사、외과치료、종류병리보고등자료진행수집급분석，병대2006년조화2011년조적자료진행비교。결과공189례청년위암환자，종류표지물적총검측례수156례（82.5%），총양성례수51례（32.7%），165례（87.3%）환자진행료전복CT증강가평소검사，행근치수술153례（81.0%）。재술후병리보고중，대종류대소진행묘술적117례（61.9%），행R0절제176례（93.1%），피평고적림파결조수중위치위8，행근치술적환자중피평고적림파결수≥15개공132례（86.3%）。2006년화2011년량조환자검측항목비교균무통계학차이。결론여2011년적위암진료규범상비，외과치료화병리진단잉존재착허다불족，포괄불능충분이용종류표지물진행위암사사，영상학검사흠전면，림파결청소여평고불부，병리보고불완정，재일정정도상급위암환자적치료화예후대래불리적영향，인차，림상실천여규범접궤박재미첩。
Objective To assess the current status of surgical treatment and pathological diagnosis of young patients with gastric cancer with reference of Ministry of Health's Guideline of Treatment and Diagnosis for Gastric Cancer (2011). Methods Clinical and pathological data of 189 patients aged≤40y with gastric cancer in Wenzhou from January 2006 to December 2011 were analyzed retrospectively.The questionnaire was designed with items of preoperative diagnostic procedures, surgical treat-ment, pathological features. Results The measurement of tumor marker was performed in 156 patient(82.5%) with a positive rate of 32.7%(51/156);165(87.3%) patients had a full abdominal enhanced CT examination and 153 cases received radical surgery(81.0%). In 117 cases (62.9%) the pathological reports described the tumor size and 176 (93.1%) patients achieved R0 resection. In patients undergoing lymph node dissection, 132 cases(86.3%) had more than 15 lymph nodes assessed and the median of assessed lymph nodes were 8. There were no significant differences in assessed items between 2006 and 2011 groups. Conclusion There are stil many deficiencies in clinical practice compared with 2011 Guideline in treatment and diagnosis for gastric cancer. Therefore the current status of diagnosis and treatment need to be improved and standardized with the reference of 2011 Guideline.