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目的研究胃癌前胃粘膜变化发展演变的规律,以及胃镜随访检查对胃癌早期发现的意义。方法对1417例患者进行胃镜检查,其中750例进行胃镜随访检查。结果1417例中首次胃镜检查即诊断为胃癌患者64例,检出率4.5%;在以后随访检查中又先后发现胃癌82例。癌前变化人群95%癌变所需时间萎缩性胃炎11.6年,肠上皮化生11.4年,异型增生5.7年,肠上皮化生(中、重度)+异型增生(中、重度)4.5年。胃癌中有许多(54.9%)并不经历肠上皮化生或异型增生阶段。结论对胃粘膜异型增生和肠上皮化生等病变患者的胃镜检查随访有利于提高胃癌(尤其是早期胃癌)的检出率;有必要更新癌前变化的概念,探索研究新的尚未认识的癌前病变,并提出新的判断指标。
Objective To study the regularity of gastric mucosal changes and their significance in the early detection of gastric cancer. Methods A total of 1417 patients underwent endoscopy, of which 750 were examined by endoscopy. Results In the 1417 cases, the first gastroscopy was diagnosed as 64 cases of gastric cancer with a detection rate of 4.5%. In the follow-up examination, 82 cases of gastric cancer were discovered. Precancerous changes 95% of the population cancer time required atrophic gastritis 11.6 years, intestinal metaplasia 11.4 years, dysplasia 5.7 years, intestinal metaplasia (moderate and severe) dysplasia (moderate and severe) 4.5 years. Much of gastric cancer (54.9%) does not undergo intestinal metaplasia or dysplasia. Conclusion Follow-up of gastroscopy in patients with gastric mucosal dysplasia and intestinal metaplasia is helpful to improve the detection rate of gastric cancer (especially early gastric cancer); it is necessary to update the concept of precancerous changes and to explore new and unrecognized cancers Pre-lesion, and put forward new judgment indicators.