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目的阐明残胃癌(RGC)的内镜和内镜超声声像图特征,提高RGC诊断水平。方法回顾性分析皖南医学院弋矶山医院内镜中心2000年6月-2010年6月间经病理确诊为RGC患者的病例资料,分析进展期RGC的内镜和内镜超声声像图特征。结果共计1127例残胃患者接受内镜检查,其中29例符合RGC诊断标准(检出率为2.57%),均为进展期。其中,男性24例,女性5例(4.8∶1);平均年龄为(64.83±10.35)岁(36～82岁)。因良性病变行胃大部切除术后5年以上的RGC患者26例,平均年龄(65.39±10.87)岁;因恶性病变手术后10年以上残胃发生的RGC患者3例,平均年龄(60.67±6.66)岁,两组年龄之间差异无统计学意义(P>0.05)。不同术式中残胃病变出现的部位比较差异有统计学意义(P<0.001)。4种不同Borrmann分型出现在上消化道不同部位比较差异有统计学意义(P<0.001);不同Borrmann分型性别比较无差异;4种不同Borrmann分型和3种不同术式之间有关联(P=0.002);4种不同Borrmann型和残胃癌前病变之间有关联(P=0.001)。6例进展期RGC患者接受了EUS检查,主要声像图特征为消化道管壁层次结构破坏、管壁增厚、呈低回声改变,EUS可显示病变侵犯深度和周围脏器、淋巴结转移情况。结论内镜下进展期RGC以BorrmannⅡ和Ⅲ为主,Borrmann分型在不同术式和不同残胃癌前病变中的表现不同,受累部位以残胃贲门、残胃小弯和后壁多见。EUS可用于评估RGC的进展情况。
Objective To elucidate the characteristics of endoscopic and endoscopic ultrasonography of residual gastric cancer (RGC) and to improve the diagnostic value of RGC. Methods We retrospectively analyzed the data of cases with pathologically diagnosed RGC from June 2000 to June 2010 in Yijishan Hospital of Wannan Medical College. The endoscopic and endoscopic ultrasonographic features of advanced RGC were analyzed. Results A total of 1127 cases of gastric residual disease patients underwent endoscopy, of which 29 cases meet the criteria for the diagnosis of RGC (detection rate of 2.57%), all were advanced. Among them, 24 males and 5 females (4.8:1), with an average age of (64.83 ± 10.35) years (36-82 years). The mean age was 65.39 ± 10.87 years old in 26 RGC patients who underwent radical gastrectomy for 5 years or more. The mean age was 60.67 ± 6.66) years old, there was no significant difference between the two groups (P> 0.05). There were significant differences in the appearance of residual gastric lesions in different surgical procedures (P <0.001). Four different Borrmann’s classification appeared in different parts of the upper digestive tract compared with the difference was statistically significant (P <0.001); Borrmann classification of different genders no difference; four different Borrmann classification and three different surgical correlation (P = 0.002). There was a correlation between four different Borrmann types and gastric precancerous lesions (P = 0.001). Six patients with advanced RGC underwent EUS. The main features of the ultrasonography were the destruction of the digestive tract wall structure, the thickening of the wall, and the hypoechoic changes. EUS could show the depth of invasion and the surrounding organs and lymph node metastases. Conclusions Borrmann Ⅱ and Ⅲ are the most common forms of endoscopic RGC. The Borrmann classification is different in different surgical procedures and different gastric precancerous lesions. The affected parts are mainly residual gastric cardia, small residual bends and posterior wall. EUS can be used to assess the progress of RGCs.