超声定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断价值的探讨(1)
【摘要】 目的：探讨超声内镜定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌诊断的价值。方法：回顾性分析病理确诊的53例Borrmann Ⅳ型胃癌的临床资料，比较常规活检及超声内镜定位下凿洞式深挖活检对Borrmann Ⅳ型胃癌的诊断结果。结果：常规胃镜首次活检诊断Borrmann Ⅳ型胃癌阳性率30.2%(16/53)，活检阴性患者多次重复活检阳性率13.5%(5/37)，常规内镜活检总阳性率为39.6%(21/53)。46例Borrmann Ⅳ型胃癌患者行超声内镜检查，诊断与病理符合率为95.5%(44/46)。21例多次活检阴性患者行超声内镜定位下凿洞式深挖活检，术后标本送病理检查阳性率61.9%(13/21)。仅2例患者活检后创面少量渗血，所有患者术后观察无出血、穿孔等并发症发生。结论：超声内镜定位下凿洞式深挖活检显著提高Borrmann Ⅳ型胃癌临床内镜活检阳性率，为Borrmann Ⅳ型胃癌的诊断提供了更有效的病理确诊依据。该操作安全性高，费用少，值得临床推广。
【关键词】 Borrmann Ⅳ型胃癌； 胃镜活检； 超声内镜； 深挖活检
, 百拇医药
中图分类号 R730.4 文献标识码 B 文章编号 1674-6805(2014)26-0063-02
【Abstract】 Objective： To evaluate the diagnostic yield of EUS-guided holing biopsy in Borrmann type Ⅳ gastric cancer.Method：The clinical diagnose data of 53 cases of Borrmann type Ⅳ gastric cancer patients who were confirmed pathologically by operation examination or gastroscopy were analyzed retrospectively.Result：The positive rate of first routine biopsy was 30.2%(16/53). The cases with negative first routine biopsies were treated with repeated biopsies(2-4 times)，and the positive rate was 13.5%(5/37).The overall positive rate of gastroscopic routine biopsy was 39.6%(21/53).46 cases were diagnosised by EUS，and the coincidence rate in diagnosing Borrmann type IV gastric cancer was 95.5%(44/46).The cases with negative gastroscopic routine biopsy were treated with EUS-guided holing biopsys， and the positive rate was 61.9%(13/21). Minor bloods oozing in 2 patients were controlled by epinephrine. Neither severe hemorrhage nor perforation was founded in any cases. Conclusion：EUS-guided holing biopsy has superiority of raising the positive rate of gastroscopic biopsy. It is an effective technique to diagnosis Borrmann type Ⅳ gastric cancer with pathological basis. And the technique is safety and inexpensiveness.
, 百拇医药
【Key words】 Borrmann type Ⅳ gastric cancer； Gastroscopic biopsy； EUS； Holing biopsy
First-author’s address： The First Affiliated Hospital of Zhejiang University，Hangzhou 310003，China
Bonrmann IV型胃癌是以癌细胞在胃壁内的弥漫浸润为特征，先累及黏膜下层，再沿胃壁四周浸润生长。胃镜下表现早期缺乏特异性，常无明显溃疡或局部肿块，仅为胃蠕动减慢或消失。常规活检甚至反复多次活检病理检出率不高，极易误诊、漏诊，并影响疾病治疗与预后。尽管超声内镜、CT、胃肠造影能提供影像学的辅助诊断依据，但无法获得病理学确诊依据。研究表明深挖活检可以获取黏膜下组织，提高黏膜下肿瘤内镜活检诊断的阳性率。本研究通过回顾性分析53例Borrmann IV型胃癌胃镜下常规活检、超声内镜检查及其定位下凿洞式深挖活检的临床资料，探讨凿洞式深挖活检对Borrmann IV型胃癌的临床诊断价值。
, http://www.100md.com
1 资料与方法
1.1 一般资料
选取2009年1月-2014年3月笔者所在医院手术及胃镜病理确诊的Borrmann Ⅳ型胃癌53例，男31例，女22例，年龄27～84岁，平均56.3岁。其中12例无明显临床症状，为常规体检时发现，其余41例表现为上腹痛腹胀11例，黑便8例，明显消瘦7例，食欲减退10例，恶心呕吐5例。53例患者均进行胃镜检查及常规活检，46例患者行超声内镜检查。对常规活检阴性者进行2～4次重复活检，21例多次活检阴性者进行超声内镜引导下凿洞式深挖活检。29例行手术治疗，其中根治性手术18例，姑息性手术11例，10例术后病理与术前内镜活检病理相符合，19例为剖腹探查确诊。最终病理检查示未分化癌2例，中分化腺癌1例，低分化腺癌37例，印戒细胞癌13例。, http://www.100md.com(周辛欣等)
【关键词】 Borrmann Ⅳ型胃癌； 胃镜活检； 超声内镜； 深挖活检
, 百拇医药
中图分类号 R730.4 文献标识码 B 文章编号 1674-6805(2014)26-0063-02
【Abstract】 Objective： To evaluate the diagnostic yield of EUS-guided holing biopsy in Borrmann type Ⅳ gastric cancer.Method：The clinical diagnose data of 53 cases of Borrmann type Ⅳ gastric cancer patients who were confirmed pathologically by operation examination or gastroscopy were analyzed retrospectively.Result：The positive rate of first routine biopsy was 30.2%(16/53). The cases with negative first routine biopsies were treated with repeated biopsies(2-4 times)，and the positive rate was 13.5%(5/37).The overall positive rate of gastroscopic routine biopsy was 39.6%(21/53).46 cases were diagnosised by EUS，and the coincidence rate in diagnosing Borrmann type IV gastric cancer was 95.5%(44/46).The cases with negative gastroscopic routine biopsy were treated with EUS-guided holing biopsys， and the positive rate was 61.9%(13/21). Minor bloods oozing in 2 patients were controlled by epinephrine. Neither severe hemorrhage nor perforation was founded in any cases. Conclusion：EUS-guided holing biopsy has superiority of raising the positive rate of gastroscopic biopsy. It is an effective technique to diagnosis Borrmann type Ⅳ gastric cancer with pathological basis. And the technique is safety and inexpensiveness.
, 百拇医药
【Key words】 Borrmann type Ⅳ gastric cancer； Gastroscopic biopsy； EUS； Holing biopsy
First-author’s address： The First Affiliated Hospital of Zhejiang University，Hangzhou 310003，China
Bonrmann IV型胃癌是以癌细胞在胃壁内的弥漫浸润为特征，先累及黏膜下层，再沿胃壁四周浸润生长。胃镜下表现早期缺乏特异性，常无明显溃疡或局部肿块，仅为胃蠕动减慢或消失。常规活检甚至反复多次活检病理检出率不高，极易误诊、漏诊，并影响疾病治疗与预后。尽管超声内镜、CT、胃肠造影能提供影像学的辅助诊断依据，但无法获得病理学确诊依据。研究表明深挖活检可以获取黏膜下组织，提高黏膜下肿瘤内镜活检诊断的阳性率。本研究通过回顾性分析53例Borrmann IV型胃癌胃镜下常规活检、超声内镜检查及其定位下凿洞式深挖活检的临床资料，探讨凿洞式深挖活检对Borrmann IV型胃癌的临床诊断价值。
, http://www.100md.com
1 资料与方法
1.1 一般资料
选取2009年1月-2014年3月笔者所在医院手术及胃镜病理确诊的Borrmann Ⅳ型胃癌53例，男31例，女22例，年龄27～84岁，平均56.3岁。其中12例无明显临床症状，为常规体检时发现，其余41例表现为上腹痛腹胀11例，黑便8例，明显消瘦7例，食欲减退10例，恶心呕吐5例。53例患者均进行胃镜检查及常规活检，46例患者行超声内镜检查。对常规活检阴性者进行2～4次重复活检，21例多次活检阴性者进行超声内镜引导下凿洞式深挖活检。29例行手术治疗，其中根治性手术18例，姑息性手术11例，10例术后病理与术前内镜活检病理相符合，19例为剖腹探查确诊。最终病理检查示未分化癌2例，中分化腺癌1例，低分化腺癌37例，印戒细胞癌13例。, http://www.100md.com(周辛欣等)
参见：首页 > 医疗版 > 疾病专题 > 消化内科 > 胃疾病 > 胃癌