青年人胃癌53例临床分析(1)
[摘要] 目的 总结青年胃癌的临床特点及诊治。方法 对53例35岁以下胃癌患者临床资料进行回顾性分析。结果 本组手术切除42例患者的随访结果:1年生存23例,包括Ⅳ期患者22例、Ⅲ期1例;2年生存10例,均为Ⅲ期患者;3年生存5例,包括Ⅱ期患者3例、Ⅲ期2例;5年生存4例,包括I期患者3例、Ⅱ期1例。11例手术未切除者均在1年内死亡;3例因合并肝脏及腹腔淋巴结转移未行手术者均在8个月内死亡。结论 青年胃癌早期临床症状缺乏特异性,起病隐匿,较难诊断。提高对青年人胃癌的诊治水平,对早期诊断、减少误诊、提高疗效、改善预后具有重要意义。
[关键词] 青年人;胃癌;误诊;治疗
[中图分类号] R735.2[文献标识码] A[文章编号] 1673-9701(2009)12-149-02
The Clinical Analysis of 53 Cases of Patients with Gastric Cancer
, http://www.100md.com
PAN Xiuyong1YANG Jinhua2ZHANG Xigui2
1.Sishui Hospital o f Gaozhou City, Guangdong 525249;2.Traditional Chinese Medicine Hospital of Gaozhou,Guangdong 525200
[Abstract] Objective To summarize the clinical characteristics and its treatment of young gastric cancer. Methods The clinical data of 53 cases of patients below 35 years age with gastric cancer were retrospectively analyzed. Results The follow-up results of 42 cases of patients of surgical resection in this group: 23 cases of 1-year survival, including 22 cases of patients with stage Ⅳ, 1 case of Ⅲ period;10 cases of 2-year survival, all patients with stage Ⅲ;5 cases of 3-year survival, including three cases of patients of the Phase Ⅱ, 2 cases of Ⅲ period;4 cases of 5-year survival, including three cases of patients of the Phase I, 1 case ofⅡ period. 11 cases of no surgical resection were dead in one year; three cases of patients combined liver and abdominal cavity due to lymph node metastasis undergoing surgery died in 8 months. Conclusion Young gastric cancer lacks specificity of early clinical symptoms, onset occult, difficult to diagnose. Improving the diagnosis and treatment of gastric cancer of young people is of great significance for early diagnosis and reducing misdiagnosis, enhancing efficacy and improving the prognosis.
, 百拇医药
[Key Words] Young people;Gastric carcinoma;Misdiagnosis;Treatment
胃癌是最常见的胃肿瘤,一般认为与幽门螺杆菌感染、环境因素、遗传因素等有关,是源于上皮的恶性肿瘤。在胃的恶性肿瘤中,腺癌占95%[1]。为提高对胃癌的诊治水平,现将我院2002~2007年收治的53例青年胃癌患者的临床资料总结如下。
1材料与方法
1.1一般资料
我院自2002~2007年共收治经手术及病理确诊的胃癌561例,其中青年人胃癌53例,占同期收治胃癌患者的9.45%。53例青年人胃癌患者中,男性22例,女性31例,男女之比为1∶1.4。年龄19~35岁,平均28.3岁。其中20岁以下2例(3.77%),20~25岁17例(32.08%),26~30岁24例(45.28%),31~35岁10例(18.87%)。有明确胃病史者7例,有胃癌家族史者2例,有家族食管癌、肝癌史者各1例。
, http://www.100md.com
1.2临床表现
本组胃癌的主要症状为上腹部疼痛,其次为恶心、腹胀、呕吐、反酸、食欲减退、消瘦、嗳气等,另有少数病例有吞咽困难,黄疸;青年人胃癌的主要体征:绝大多数患者有上腹部明显压痛,其次为腹部包块、幽门梗阻、消瘦、贫血、腹水等;从自觉有症状至入院,6个月以内者30例(56.60%),7~12个月者18例(33.96%),13~24个月者5例(9.44%)。
1.3胃癌分型及部位
按肿瘤TNM分期,I期6例(11.32%),Ⅱ期10例(18.87%),Ⅲ期15例(28.30%),Ⅳ期22例(41.51%)。病变部位:胃窦部34例(64.15%),胃体13例(24.53%),胃底6例(11.32%)。组织学分型:低分化腺癌23例(43.40%),未分化癌21例(39.62%),粘液细胞癌6例(11.32%),印戒细胞癌3例(5.66%)。进展期胃癌45例(84.91%),10例(18.87%)有柏油样便,5例(93.43%)左锁骨上淋巴结肿大,4例(7.55%)触及腹部肿块。其中34例(64.15%)发生肿瘤在腹膜、大网膜、肝脏、胰腺以及卵巢等部位的转移。
, 百拇医药
1.4诊断及误诊情况
主要的诊断方法:胃镜及钡餐透视检查。53例患者中,45例行胃镜检查,诊断为胃癌30例,可疑胃癌12例,合并十二指肠球部溃疡2例,误诊为胃溃疡8例,胃窦黏膜隆起性质待定1例。34例行钡餐透视检查,诊断胃癌26例,可疑胃癌8例。
本组53例胃癌患者中,在外院及我院首次就诊时共误诊24例(45.28%),分别误诊为消化性溃疡9例,胆汁反流性胃炎4例,结核性腹膜炎3例,胆囊炎2例,上消化道出血2例,急性肾功能衰竭、结肠肝区癌、肝癌及卵巢肿瘤各1例。
1.5治疗
本组53例患者中,因合并肝脏及腹腔淋巴结转移,未行手术,给予内科综合抗肿瘤和对症治疗3例;行根治性切除术26例,姑息性切除术16例,未切除者行胃-空肠吻合术5例、探查术3例,总手术切除率79.25%(42/53)。术后病理证实有淋巴结转移43例,占手术病例的86.0%(43/50),其中手术切除者35例有淋巴结转移,占手术切除病, http://www.100md.com(潘修勇 杨进华 张锡贵)
[关键词] 青年人;胃癌;误诊;治疗
[中图分类号] R735.2[文献标识码] A[文章编号] 1673-9701(2009)12-149-02
The Clinical Analysis of 53 Cases of Patients with Gastric Cancer
, http://www.100md.com
PAN Xiuyong1YANG Jinhua2ZHANG Xigui2
1.Sishui Hospital o f Gaozhou City, Guangdong 525249;2.Traditional Chinese Medicine Hospital of Gaozhou,Guangdong 525200
[Abstract] Objective To summarize the clinical characteristics and its treatment of young gastric cancer. Methods The clinical data of 53 cases of patients below 35 years age with gastric cancer were retrospectively analyzed. Results The follow-up results of 42 cases of patients of surgical resection in this group: 23 cases of 1-year survival, including 22 cases of patients with stage Ⅳ, 1 case of Ⅲ period;10 cases of 2-year survival, all patients with stage Ⅲ;5 cases of 3-year survival, including three cases of patients of the Phase Ⅱ, 2 cases of Ⅲ period;4 cases of 5-year survival, including three cases of patients of the Phase I, 1 case ofⅡ period. 11 cases of no surgical resection were dead in one year; three cases of patients combined liver and abdominal cavity due to lymph node metastasis undergoing surgery died in 8 months. Conclusion Young gastric cancer lacks specificity of early clinical symptoms, onset occult, difficult to diagnose. Improving the diagnosis and treatment of gastric cancer of young people is of great significance for early diagnosis and reducing misdiagnosis, enhancing efficacy and improving the prognosis.
, 百拇医药
[Key Words] Young people;Gastric carcinoma;Misdiagnosis;Treatment
胃癌是最常见的胃肿瘤,一般认为与幽门螺杆菌感染、环境因素、遗传因素等有关,是源于上皮的恶性肿瘤。在胃的恶性肿瘤中,腺癌占95%[1]。为提高对胃癌的诊治水平,现将我院2002~2007年收治的53例青年胃癌患者的临床资料总结如下。
1材料与方法
1.1一般资料
我院自2002~2007年共收治经手术及病理确诊的胃癌561例,其中青年人胃癌53例,占同期收治胃癌患者的9.45%。53例青年人胃癌患者中,男性22例,女性31例,男女之比为1∶1.4。年龄19~35岁,平均28.3岁。其中20岁以下2例(3.77%),20~25岁17例(32.08%),26~30岁24例(45.28%),31~35岁10例(18.87%)。有明确胃病史者7例,有胃癌家族史者2例,有家族食管癌、肝癌史者各1例。
, http://www.100md.com
1.2临床表现
本组胃癌的主要症状为上腹部疼痛,其次为恶心、腹胀、呕吐、反酸、食欲减退、消瘦、嗳气等,另有少数病例有吞咽困难,黄疸;青年人胃癌的主要体征:绝大多数患者有上腹部明显压痛,其次为腹部包块、幽门梗阻、消瘦、贫血、腹水等;从自觉有症状至入院,6个月以内者30例(56.60%),7~12个月者18例(33.96%),13~24个月者5例(9.44%)。
1.3胃癌分型及部位
按肿瘤TNM分期,I期6例(11.32%),Ⅱ期10例(18.87%),Ⅲ期15例(28.30%),Ⅳ期22例(41.51%)。病变部位:胃窦部34例(64.15%),胃体13例(24.53%),胃底6例(11.32%)。组织学分型:低分化腺癌23例(43.40%),未分化癌21例(39.62%),粘液细胞癌6例(11.32%),印戒细胞癌3例(5.66%)。进展期胃癌45例(84.91%),10例(18.87%)有柏油样便,5例(93.43%)左锁骨上淋巴结肿大,4例(7.55%)触及腹部肿块。其中34例(64.15%)发生肿瘤在腹膜、大网膜、肝脏、胰腺以及卵巢等部位的转移。
, 百拇医药
1.4诊断及误诊情况
主要的诊断方法:胃镜及钡餐透视检查。53例患者中,45例行胃镜检查,诊断为胃癌30例,可疑胃癌12例,合并十二指肠球部溃疡2例,误诊为胃溃疡8例,胃窦黏膜隆起性质待定1例。34例行钡餐透视检查,诊断胃癌26例,可疑胃癌8例。
本组53例胃癌患者中,在外院及我院首次就诊时共误诊24例(45.28%),分别误诊为消化性溃疡9例,胆汁反流性胃炎4例,结核性腹膜炎3例,胆囊炎2例,上消化道出血2例,急性肾功能衰竭、结肠肝区癌、肝癌及卵巢肿瘤各1例。
1.5治疗
本组53例患者中,因合并肝脏及腹腔淋巴结转移,未行手术,给予内科综合抗肿瘤和对症治疗3例;行根治性切除术26例,姑息性切除术16例,未切除者行胃-空肠吻合术5例、探查术3例,总手术切除率79.25%(42/53)。术后病理证实有淋巴结转移43例,占手术病例的86.0%(43/50),其中手术切除者35例有淋巴结转移,占手术切除病, http://www.100md.com(潘修勇 杨进华 张锡贵)