Kato Mototsugu, Ono Shoko, Mabe Katsuhiro, Sakamoto Naoya, Asaka Masahiro
Division of Endoscopy, Hokkaido University Hospital.
Nihon Rinsho. 2013 Aug;71(8):1429-35.
Almost all gastric cancers including intestinal type and diffuse type develop from background of H. pylori infection of the gastric mucosa. In treatment of gastric cancer, the development of endoscopic technique expanded the indication of endoscopic treatment for early gastric cancer. Residual cancers due to incomplete resection occur within two years after endoscopic treatment. However, metachronous cancers continue to occur for long-term after endoscopic treatment of primary cancer. Multi-center, randomized controlled trial in Japan showed that H. pylori eradication significantly reduced the incidence of metachronous cancer after endoscopic resection. Severe atrophy is high risk factor on metachronous gastric cancer after successful eradication. Because H. pylori eradication after endoscopic treatment of early gastric cancer have been covered under public health insurance, positive eradication therapy for H. pylori infection is expected to reduce metachronous cancer.
几乎所有的胃癌，包括肠型和弥漫型，都在胃黏膜幽门螺杆菌感染的背景下发生。在胃癌治疗中，内镜技术的发展扩大了早期胃癌内镜治疗的适应证。内镜治疗后因切除不完全而残留的癌症发生在内镜治疗后的两年内。然而，异时性癌在原发性癌症内镜治疗后会长期持续发生。日本的多中心随机对照试验表明，根除幽门螺杆菌可显著降低内镜切除术后异时性癌的发生率。严重萎缩是根除成功后发生异时性胃癌的高危因素。由于早期胃癌内镜治疗后根除幽门螺杆菌已纳入公共医疗保险，因此对幽门螺杆菌感染进行积极的根除治疗有望减少异时性癌的发生。
