CAJ | 학술논문

目的分析早期胃癌的普通白光内镜下特征,以及早期胃癌内镜下表现与其病理类型的关系.方法对2010年1月至2014年7月由胃镜检查发现并经病理确诊的130例早期胃癌患者进行回顾性研究.采用巴黎分类标准分类,并按病灶最大径分为微小胃癌(最大径≤0.5 cm)、小胃癌(0.5 cm＜最大径≤1.0 cm),以及最大径＞1.0 cm的早期胃癌,分析其在白光内镜下的病灶形态与病理特征.计数资料的比较采用卡方检验或Fisher确切概率法.结果早期胃癌以分化型为主(91％,118/130),形态学分类上以0-Ⅱc型最多见(55％,72/130),色调变化以发红多见(75％,97/130).边界清晰(93％,121/130)及表面不规则(89％,116/130)是白光内镜下早期胃癌最显著的特征,但微小胃癌中病灶表面不规则者较少见(3/10).83％(108/130)的早期胃癌病灶周围黏膜有萎缩和(或)肠上皮化生.凹陷型病灶(0-Ⅱc和0-Ⅲ型)中58％(42/73)边缘部呈毛刺状、42％(31/73)并发溃疡,而表面覆白色不透明物质多见于隆起型病灶(0-Ⅰ和0-Ⅱa型,37％,17/46).未分化型早期胃癌全部为0-Ⅱ型,且以0-Ⅱc型(8/12)多见,未分化型癌色调发白或红白相间较多见(7/12).结论在白光内镜下注意胃黏膜局部色调的变化,以及边界清晰和表面不规则的病灶,有助于发现早期胃癌.病灶的形态和色调有助于预判肿瘤的病理类型.
목적 분석조기위암적보통백광내경하특정,이급조기위암내경하표현여기병리류형적관계.방법 대2010년1월지2014년7월유위경검사발현병경병리학진적130례조기위암환자진행회고성연구.채용파려분류표준분류,병안병조최대경분위미소위암(최대경≤0.5 cm)、소위암(0.5 cm＜최대경≤1.0 cm),이급최대경＞1.0 cm적조기위암,분석기재백광내경하적병조형태여병리특정.계수자료적비교채용잡방검험혹Fisher학절개솔법.결과 조기위암이분화형위주(91％,118/130),형태학분류상이0-Ⅱc형최다견(55％,72/130),색조변화이발홍다견(75％,97/130).변계청석(93％,121/130)급표면불규칙(89％,116/130)시백광내경하조기위암최현저적특정,단미소위암중병조표면불규칙자교소견(3/10).83％(108/130)적조기위암병조주위점막유위축화(혹)장상피화생.요함형병조(0-Ⅱc화0-Ⅲ형)중58％(42/73)변연부정모자상、42％(31/73)병발궤양,이표면복백색불투명물질다견우륭기형병조(0-Ⅰ화0-Ⅱa형,37％,17/46).미분화형조기위암전부위0-Ⅱ형,차이0-Ⅱc형(8/12)다견,미분화형암색조발백혹홍백상간교다견(7/12).결론 재백광내경하주의위점막국부색조적변화,이급변계청석화표면불규칙적병조,유조우발현조기위암.병조적형태화색조유조우예판종류적병리류형.
Objective To analyze the characteristics of early gastric cancer under white light endoscopy,and explore the relationship between endoscopic findings and pathological type of gastric cancer.Methods From January 2010 to July 2014,130 pathologically comfirmed early gastric cancer detected under white light endoscopy were retrospectively analyzed.The cancers were classified according to Paris classification standard.According to maximum diameter,the lesions were divided into micro gastric cancer (≤0.5 cm),small gastric cancer (0.5 cm＜,and ≤1.0 cm) and other early gastric cancer (over 1.0 cm).The morphology of lesions under white light endoscopy and under the microscope were analyzed.Chi square test or Fisher exact probability test was performed for enumeration data comparison.Results The majority of early gastric cancer was differentiated type (91％,118/130).The most common macroscopic morphology was 0-Ⅱe type (55 ％,72/130),and the color of lesions was mostly red (75 ％,97/130).The significant characteristics of early gastric cancer under white light endoscopy was clear boundary (93％,121/130) and irregular surface (89％,116/130).However,irregular surface was rare in micro gastric cancer (3/10).There were atrophic gastritis and/or intestinal metaplasia in surrounding mucosa of 83％ (108/130) of early gastric cancer.Encroachment and accompanied by ulceration were more common in depressed lesions (0-Ⅱc and 0-Ⅲ type,58％ (42/73) and 42％ (31/73),respectively) and the white opaque of substance on the top was more common in elevated lesions (0-Ⅰ and 0-Ⅱa type 37％ (17/46)).Moreover,all the undifferentiated gastric cancers were type 0-Ⅱ in which 0-Ⅱ c type (8/12) predominated.The color of undifferentiated gastric cancers was mostly white or white and red (7/12).Conclusions Under white light endoscopy,the color change of gastric mucosa,the clear boundary line and irregular surface should be taken notice,which may facilitate to find early gastric cancer.Tumor pathological type may be predicted based on macroscopic morphology and colour.