CAJ | 학술논문

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年间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年间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(x2 =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),不同形态分型间的淋巴结转移率比较差异有统计学意义(x2=52.1951,P＜0.0001),其中0-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.
목적 평개위암학과군적건립시부능제고조기위암적수술솔.방법 회고성분석1996년1월지2011년12월적16년간서금의원위암절제술시행정황,비교2005년위암학과군건립전후조기위암수술솔적변화정황.동시대2005년위암학과군건립후7년간조기위암수술후병리안파려천표위장종류형태학분형표준진행분류,분석조기위암형태분형특점여림파결전이정황.결과 16년간서금의원공시행위암절제술6026례,기중경술후병리증실적조기위암985례,매년적조기위암수술솔재6.08％～ 22.45％,평균위16.35％.2005년위암학과군성립후,평균매년조기위암수술솔(19.64％,751/3823)교위암학과군성립전(10.62％,234/2203)현저증고,차이유통계학의의(x2 =83.2026,P＜0.0001),차매년적조기위암수술솔최고체22.45％(154/686).대학과군후건립후7년간공751례조기위암진행형태분형,기중요함형조기위암공계588례,점전조적78.30％；751례조기위암평균림파결전이솔위12.92％(97/751),불동형태분형간적림파결전이솔비교차이유통계학의의(x2=52.1951,P＜0.0001),기중0-Ⅲ형조기위암적림파결전이솔최고,체31.71％(39/123).결론 조기위암수술솔적제고유뢰우다학과적협작,내경의사수가강대조기위암내경하형태적인식,제고대요함성병조적감별능력.
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 cancers were selected to calculate the annual proportion and to analyze the relation between morphology and lymphatic 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 fluctuated from 6.08％ to 22.45％ with the average of 16.35％.The establishment of the multi-disciplinary collaboration 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 significant (x2 =83.2026,P ＜ 0.0001).There were 751 cases of early gastric cancers confirmed during the 7years 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 0-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.