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目的:探讨胃黏液腺癌的临床病理和CT特征。方法:回顾性分析507例行根治或姑息性切除术的胃癌病例的临床病理资料(20例黏液腺癌和487例非黏液腺癌)及术前的多层螺旋CT检查结果;对比分析20例黏液腺癌和38例非黏液腺癌的CT征象(CT轴位图像上肿瘤最大径、厚度、大体分型及强化方式)。结果:通过术前电镜活检,仅25.0%(5/20)的胃黏液腺癌得到确诊。20例黏液腺癌均为进展期胃癌,487例非黏液腺癌中早期胃癌占16.8%(82/487),但差异无统计学意义(P=0.056)。与非黏液腺癌相比,黏液腺癌肿瘤较大[(6.9±4.0)cm比(4.4±2.3)cm,P=0.011],淋巴结转移率较高(85.0%比60.6%,P=0.028),且Ⅱ～Ⅳ期病例较多(95.0%比72.3%,P=0.025);二者在CT轴位图像上肿瘤最大径(P=0.008)、厚度(P=0.001)、大体分型(P=0.037)和强化方式(P=0.000)间均存在显著差异。但黏液与非黏液腺癌在年龄、性别、肿瘤位置、远处转移和根治性切除率间均无差异。结论:胃黏液腺癌病例数少且多属进展期,通过内镜活检判断黏液腺癌的敏感度较低,而多层螺旋CT则有助于鉴别黏液和非黏液腺癌。
Objective: To investigate the clinicopathological features and CT features of gastric mucinous adenocarcinoma. Methods: The clinical and pathological data of 507 cases of gastric cancer treated by radical or palliative resection (20 cases of mucinous adenocarcinoma and 487 cases of non-mucinous adenocarcinoma) and multi-slice spiral CT were retrospectively analyzed. Twenty cases Mucinous adenocarcinoma and 38 cases of non-mucinous adenocarcinoma (maximal diameter of tumor, thickness, general classification and enhancement mode on CT axial images). Results: Only 25.0% (5/20) of gastric mucinous adenocarcinomas were confirmed by preoperative electron microscopy. All 20 cases of mucinous adenocarcinoma were advanced gastric cancer, and 48.7 cases of early mucinous adenocarcinoma accounted for 16.8% (82/487) of early gastric cancer, but the difference was not statistically significant (P = 0.056). Compared with non-mucinous adenocarcinoma, mucinous adenocarcinoma had a higher rate of lymph node metastasis ((6.9 ± 4.0) cm vs (4.4 ± 2.3) cm, P = 0.011) (P = 0.008), thickness (P = 0.001), general classification (P = 0.008), P value = 0.037) and fortification (P = 0.000) were significantly different. However, there was no difference between mucinous and non-mucinous adenocarcinomas in age, gender, tumor location, distant metastasis and radical resection rate. Conclusions: The number of gastric mucinous adenocarcinoma is small and mostly advanced. The sensitivity of endoscopic mucinous adenocarcinoma for detecting mucinous adenocarcinoma is low, while multi-slice spiral CT is helpful to distinguish mucinous and non-mucinous adenocarcinoma.