Offerhaus G J, van de Stadt J, Huibregtse K, Tersmette A C, Tytgat G N
Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Cancer. 1989 Aug 1;64(3):698-703. doi: 10.1002/1097-0142(19890801)64:3<698::aid-cncr2820640322>3.0.co;2-d.
Endoscopic bioptic screening of 504 asymptomatic postgastrectomy patients, 15 to 46 years after initial surgery, revealed ten gastric stump cancers of which six turned out to be early cancers; three of the early carcinomas were found during follow-up after prior severe dysplasia. At first endoscopy mild dysplasia was found in 58, moderate dysplasia in 11, and severe dysplasia in none of the patients. Follow-up biopsies in 177 patients showed mild dysplasia in 30, moderate dysplasia in six, and severe dysplasia in six patients. Regression of severe dysplasia was not observed. Both progression and regression of mild and moderate dysplasia occurred. At the first endoscopy the frequency of atrophy, intestinal metaplasia, cystic dilatation of glands, and foveolar hyperplasia in the stomal biopsy specimens was 45%, 35%, 54%, and 47%, respectively; during follow-up, 47%, 48%, 56%, and 56% respectively. These four lesions were significantly more frequent in the biopsy specimens of patients with gastric carcinoma or dysplasia than in the other patients and they were present in the environment of the tumor in all the surgical specimens of the six early cancers detected by the screening. Preoperatively a combination of these four lesions could be demonstrated in only those early gastric cancer patients, in whom more than eight stomal biopsy specimens were taken. Of 34 patients with severe atrophy in three or more stomal biopsy specimens taken at the same time, two manifested early stump cancer during follow-up. Severe dysplasia is a marker of malignancy and demands close follow-up; the value of mild and moderate dysplasia is less clear. The combination of atrophy, especially severe atrophy, intestinal metaplasia, cystic dilatation, and foveolar hyperplasia in the biopsy specimens of a single patient may also point to increased cancer risk. It is advisable to obtain multiple biopsy specimens of the anastomosis, also because early gastric cancer may occur without a suspect macroscopic appearance.
对504例无症状的胃切除术后患者进行了内镜活检筛查，这些患者在初次手术后15至46年，发现了10例残胃癌，其中6例为早期癌；3例早期癌是在先前重度发育异常后的随访中发现的。初次内镜检查时，58例患者发现轻度发育异常，11例患者发现中度发育异常，无患者发现重度发育异常。177例患者的随访活检显示，30例患者有轻度发育异常，6例患者有中度发育异常，6例患者有重度发育异常。未观察到重度发育异常的消退情况。轻度和中度发育异常均有进展和消退情况。初次内镜检查时，吻合口活检标本中萎缩、肠化生、腺体囊性扩张和小凹增生的发生率分别为45%、35%、54%和47%；随访期间分别为47%、48%、56%和56%。这四种病变在胃癌或发育异常患者的活检标本中比在其他患者中明显更常见，并且在筛查发现的6例早期癌的所有手术标本中均存在于肿瘤周围。术前仅在那些取了8个以上吻合口活检标本的早期胃癌患者中能证实这四种病变的组合。在同时取了3个或更多吻合口活检标本且有严重萎缩的34例患者中，2例在随访期间出现早期残胃癌。重度发育异常是恶性肿瘤的标志物，需要密切随访；轻度和中度发育异常的价值尚不清楚。单个患者活检标本中萎缩（尤其是严重萎缩）、肠化生、囊性扩张和小凹增生的组合也可能提示癌症风险增加。可取多个吻合口活检标本，这也是因为早期胃癌可能在没有可疑肉眼外观的情况下发生。
