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本文对60例早期胃癌病例中的浅表广泛型、微小型、多发性等特殊类型早期胃癌诊断、治疗的总结资料进行了综合论述。浅表广泛型者胃镜下特点是病变浅表而广泛,界限多不清楚,不易准确判断范围,临床上常估计过小,在行手术切除时易造成切断端的残留癌。故应在手术前应用胃镜定出范围,以便完整的切除。微小型者胃镜下特点是病变微小,形态不明显与正常粘膜或良性病变不易区别,常为多发性或与其他病灶并发,镜检常致漏误。本组9例微小癌中有4例“一点癌”经胃镜活检诊断为癌,手术切除后经连续切片原部位再未发现癌组织。多发性者胃镜下特点,主癌病灶容易发现,副癌病灶因较微小而易漏误,特别是对伴有萎缩性胃炎、肠上皮化生、不典型增生者要注意检查,有无多发的副癌病灶。治疗上多数做根治性大部胃切除术,少数发生在远、近不同部位者应行全胃切除术,淋巴结清除到Ⅱ站。
This article comprehensively discusses the summary data of the diagnosis and treatment of special types of early gastric cancer in 60 cases of early gastric cancer including superficial, micro, and multiple types of early gastric cancer. The characteristics of superficial superficial gastroscopy are superficial and broad lesions, and the boundaries are often unclear. It is not easy to accurately determine the range. Clinically, it is often estimated that it is too small, and the residual cancer at the severed end is easily caused when surgical resection is performed. Therefore, the scope should be set before the operation to complete the resection. Microscopic endoscopy is characterized by small lesions, the shape is not easy to distinguish with normal mucosa or benign lesions, often multiple or concurrent with other lesions, microscopy often lead to errors. In this group of 9 cases of microcarcinoma, 4 cases of “single cancer” were diagnosed as cancer by gastroscope biopsy. After surgical resection, no cancer tissue was found after continuous sectioning of the original site. Multiple endoscopic features, the main cancer lesions are easy to find, vice cancer lesions due to smaller and easy to miss, especially with atrophic gastritis, intestinal metaplasia, atypical hyperplasia should pay attention to check whether there are multiple Paraneoplastic lesions. The majority of patients undergoing radical gastrectomy are treated with the majority of patients undergoing total gastrectomy in distant and near-distal sites, and lymph nodes are cleared to site II.