内科学8版胃癌课件.pptx

1、Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege讲授目的和要求讲授目的和要求1.1.掌握本病的诊断要点掌握本病的诊断要点2.2.熟悉本病的临床表现熟悉本病的临床表现 3.3.了解本病的病因、发病机制了解本病的病因、发病机制Department of GastroenterologyDepartment

2、of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege讲授主要内容讲授主要内容病因和发病机制病因和发病机制病理病理临床表现临床表现胃镜检查胃镜检查实验室实验室检查检查X X线钡餐线钡餐诊断诊断并发症并发症治疗治疗Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital

3、of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege概述概述胃癌系来源于胃癌系来源于胃黏膜上皮胃黏膜上皮的恶性肿瘤，主要是胃腺癌的恶性肿瘤，主要是胃腺癌20082008年新诊断胃癌近年新诊断胃癌近100100万例，病死人数万例，病死人数7474万，占恶性肿万，占恶性肿瘤诊断的第瘤诊断的第4 4位和恶性肿瘤病死率的第位和恶性肿瘤病死率的第2 2位位2/32/3分布于发展中国家，地理分布上以分布于发展中国家，地理分布上以日本日本和和中国中国等东亚等东亚国家为高发国家为高发我国我国北方北方

4、发病率高于发病率高于南方南方，农村农村高于高于城市城市，男性发病率和，男性发病率和死亡率均高于女性，死亡率均高于女性，55-7055-70岁为高发年龄段岁为高发年龄段全国平均死亡率约全国平均死亡率约16/1016/10万（男性万（男性21/1021/10万，女性万，女性10/1010/10万）万）Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu M

5、edical CollegeCollege病因和发病机制胃癌的发生是一个多因素、多步骤进行性发展的过程胃癌的发生是一个多因素、多步骤进行性发展的过程 不良环境不良环境、饮食饮食及及HpHp多种因素作用下，多种因素作用下，COX-2COX-2及及生长因子生长因子等介导发生连续性慢性炎症，由等介导发生连续性慢性炎症，由慢性炎症慢性炎症-萎缩性胃炎萎缩性胃炎-萎萎缩性胃炎伴肠化缩性胃炎伴肠化-异型增生异型增生-而逐渐向而逐渐向胃癌胃癌演变演变 相关癌基因相关癌基因:rasras、bcl-2bcl-2、c-mycc-myc 相关抑癌基因相关抑癌基因:p53 p53、APC APC、DCC DCC、MC

6、C MCC 相关生长因子相关生长因子:EGF EGF、TGF-TGF-Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-环境和饮食因素环境和饮食因素环境因素环境因素美国的日本移民，胃癌发病率逐代下降美国的日本移民，胃癌发病率逐代下降火山岩地带、高泥碳土壤、水土含硝酸盐过多、微

7、量元素火山岩地带、高泥碳土壤、水土含硝酸盐过多、微量元素比例失调、化学污染可参与胃癌的发生比例失调、化学污染可参与胃癌的发生饮食因素饮食因素多吃新鲜水果和蔬菜可降低胃癌的发生多吃新鲜水果和蔬菜可降低胃癌的发生经常食用霉变食品、咸菜、腌制烟熏食品以及过多的食盐，经常食用霉变食品、咸菜、腌制烟熏食品以及过多的食盐，增加胃癌的危险性增加胃癌的危险性Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliate

8、d Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-环境和饮食因素环境和饮食因素食物中食物中硝酸盐硝酸盐可以被细菌还原成可以被细菌还原成亚硝酸盐亚硝酸盐，与胺，与胺结合生成结合生成亚硝胺亚硝胺胃内胃内细菌细菌增加可以促进增加可以促进亚硝酸盐类亚硝酸盐类致癌物的产生致癌物的产生 慢性胃炎慢性胃炎、胃部分切除胃部分切除、老年人老年人Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu M

9、edical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-感染因素感染因素HpHp Hp Hp与胃癌有共同的流行病学特点与胃癌有共同的流行病学特点,胃癌高发区胃癌高发区HpHp感染率感染率高高;Hp;Hp抗体阳性人群发生胃癌的危险性高于阴性人群抗体阳性人群发生胃癌的危险性高于阴性人群 动物实验示动物实验示:Hp:Hp可诱发胃癌可诱发胃癌 1994 1994年国际癌肿研究机构将年国际癌肿研究机构将HpHp定为定为类类致癌原致癌原Department of Gastroenterolog

10、yDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-感染因素感染因素HpHp致胃癌的可能机制致胃癌的可能机制:1 1、HpHp导致的慢性炎症导致的慢性炎症内源性致突变原内源性致突变原 胃黏膜萎缩、肠化、不典型增生胃黏膜萎缩、肠化、不典型增生癌变癌变2 2、HpHp还原亚硝酸盐，还原亚硝酸盐，N N亚硝基化合物是公认的致癌物亚硝基化合物

11、是公认的致癌物3 3、HpHp代谢产物促进上皮细胞变异代谢产物促进上皮细胞变异Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-感染因素感染因素其他感染因素其他感染因素 EBEB病毒病毒Department of GastroenterologyDepartment of G

12、astroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-遗传因素遗传因素胃癌有明显的胃癌有明显的家族聚集倾向家族聚集倾向，家族发病率高于人群，家族发病率高于人群2-32-3倍倍 据历史记载，拿破仑一家三代人中大多死于胃癌：据历史记载，拿破仑一家三代人中大多死于胃癌：祖父祖父死于胃癌；父亲死于胃癌；死于胃癌；父亲死于胃癌；三个妹妹三个妹妹也均患胃癌；他也均患胃癌；他本本人

13、人也于也于18211821年死于胃癌年死于胃癌少数胃癌属遗传性胃癌易感综合征，少数胃癌属遗传性胃癌易感综合征，浸润性胃癌浸润性胃癌有更高的有更高的家族发病倾向家族发病倾向Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-癌前状态癌前状态癌前疾病癌前疾病-指与胃癌相关的胃良性疾

14、病，有发生胃癌的危险指与胃癌相关的胃良性疾病，有发生胃癌的危险癌前病变癌前病变指易转变成癌组织的病理组织学变化，主要指指易转变成癌组织的病理组织学变化，主要指异型增生异型增生 肠型化生：分小肠型和大肠型肠型化生：分小肠型和大肠型 异型增生：异型增生：胃黏膜腺管结构及上皮细胞失去正常的状态出胃黏膜腺管结构及上皮细胞失去正常的状态出现异型性改变，组织学上介于良恶性之间现异型性改变，组织学上介于良恶性之间Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengd

15、u Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病因和发病机制病因和发病机制-癌前状态癌前状态肠上皮化生、萎缩性胃炎及异型增生肠上皮化生、萎缩性胃炎及异型增生胃息肉胃息肉 炎性息肉：多炎性息肉：多222cmcm的广基息肉的广基息肉胃溃疡胃溃疡 发生率约发生率约0.5%0.5%2%2%，多因溃疡边缘的炎症、糜烂、再，多因溃疡边缘的炎症、糜烂、再生及异型增生所致生及异型增生所致残胃炎残胃炎 毕毕式胃大部切除术后式胃大部切除术后10101515年发生，残胃癌发生率年发生，残胃癌发生率约约0.6%0.6%

16、2.5%2.5%Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病理病理好发部位好发部位 胃窦胃窦(58%)(58%)、贲门、贲门(20%)(20%)、胃体、胃体(15%)(15%)、全胃或大部、全胃或大部 分胃分胃(7%)(7%)早期胃癌早期胃癌 病灶局限且深度不超过黏膜下层的胃癌，而不论有无淋病灶局

17、限且深度不超过黏膜下层的胃癌，而不论有无淋巴结转移巴结转移进展期胃癌进展期胃癌 胃癌深度超过黏膜下层，侵及肌层者称中期胃癌胃癌深度超过黏膜下层，侵及肌层者称中期胃癌；侵及；侵及浆膜或浆膜外者称晚期胃癌浆膜或浆膜外者称晚期胃癌Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病理病理Department o

18、f GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病理病理-组织病理学组织病理学按腺体的形成及粘液分泌能力又可分为按腺体的形成及粘液分泌能力又可分为 乳头状腺癌、管状腺癌、粘液腺癌、印戒细胞癌、混合乳头状腺癌、管状腺癌、粘液腺癌、印戒细胞癌、混合性腺癌、腺鳞癌、髓样癌、肝样腺癌、鳞状细胞癌和未性腺癌、腺鳞癌、髓样癌、肝样腺癌、鳞

19、状细胞癌和未分化癌分化癌 按分化程度按分化程度分化良好、分化中等、分化差分化良好、分化中等、分化差Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege病理病理-侵袭与转移侵袭与转移直接蔓延直接蔓延 直接侵入邻近器官，直接侵入邻近器官，胃底贲门癌胃底贲门癌常侵犯食管、肝及大网常侵犯食管、肝及大网膜，膜，胃体癌

20、胃体癌则侵犯大网膜、肝及胰腺则侵犯大网膜、肝及胰腺淋巴转移淋巴转移 先局部淋巴结，再到远处淋巴结，最常见，先局部淋巴结，再到远处淋巴结，最常见，VirchowVirchow淋巴淋巴结结血行播散血行播散 以累及肝脏多见，其次肺、腹膜、肾上腺、肾、脑、骨髓以累及肝脏多见，其次肺、腹膜、肾上腺、肾、脑、骨髓腹腔内种植腹腔内种植癌细胞脱落入腹腔种植于肠壁和盆腔，癌细胞脱落入腹腔种植于肠壁和盆腔，如种植于卵巢称如种植于卵巢称KrukenbergKrukenberg瘤瘤Department of GastroenterologyDepartment of GastroenterologyThe First

21、 Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege临床表现临床表现-症状症状早期胃癌早期胃癌 多无症状，部分患者可有消化不良症状多无症状，部分患者可有消化不良症状进展期胃癌进展期胃癌 上腹痛（餐后加重）、纳差、厌食、乏力、体重减轻上腹痛（餐后加重）、纳差、厌食、乏力、体重减轻并发症或转移症状并发症或转移症状累及食管下段累及食管下段-咽下困难、咽下困难、幽门梗阻幽门梗阻-恶心、呕吐恶心、呕吐上消化道出血上消化道出血-呕血或黑粪呕血或黑粪胃癌胃

22、癌肝转移肝转移-右上腹痛、黄疸或发热右上腹痛、黄疸或发热胃癌肺转移胃癌肺转移-咳嗽、呃逆、咯血咳嗽、呃逆、咯血胃癌胸膜转移胃癌胸膜转移胸腔积液、呼吸困难胸腔积液、呼吸困难胃癌胰腺转移胃癌胰腺转移背部反射性疼痛背部反射性疼痛Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege临床表现临床表现-体征体征早期胃癌

23、早期胃癌 无明显体征无明显体征晚期胃癌晚期胃癌上腹部包块，上腹压痛上腹部包块，上腹压痛胃癌胃癌肝转移肝转移 肝大、黄疸、腹水肝大、黄疸、腹水胃癌胃癌腹膜转移腹膜转移 腹水、移动性浊音腹水、移动性浊音侵犯门静脉或脾静脉侵犯门静脉或脾静脉脾脏增大脾脏增大远处淋巴结转移远处淋巴结转移VirchowVirchow淋巴结淋巴结Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of

24、 Chengdu Medical CollegeCollege胃镜检查胃镜检查胃镜结合黏膜活检是诊断胃癌最可靠的手段。确诊率达胃镜结合黏膜活检是诊断胃癌最可靠的手段。确诊率达959599%99%以上以上早期胃癌早期胃癌 好发部位：好发部位：胃窦及胃体胃窦及胃体 胃镜下表现：胃镜下表现：息肉样隆起或凹陷、平坦但黏膜粗糙、触息肉样隆起或凹陷、平坦但黏膜粗糙、触 之易出血，斑片状充血及糜烂之易出血，斑片状充血及糜烂染色胃镜染色胃镜、放大胃镜放大胃镜、窄带光成像窄带光成像和和激光共聚焦激光共聚焦胃镜胃镜可以提高诊断率可以提高诊断率Department of GastroenterologyDepart

25、ment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查早期胃癌内镜分类法：早期胃癌内镜分类法：型（息肉样型）：广基无蒂，常型（息肉样型）：广基无蒂，常2cm2cm 型（浅表型）：本型最常见，又分三个亚型型（浅表型）：本型最常见，又分三个亚型 a a型（浅表隆起型）：病变稍高出黏膜，型（浅表隆起型）：病变稍高出黏膜，0.50.5cmcm b b型（浅表平坦型）：病变

26、表面粗糙呈颗粒状型（浅表平坦型）：病变表面粗糙呈颗粒状 c c型（浅表凹陷型）：凹陷型（浅表凹陷型）：凹陷0.50.5cmcm，底面粗糙，底面粗糙 型（溃疡型）：黏膜糜烂比型（溃疡型）：黏膜糜烂比cc型深，但不超过黏膜下型深，但不超过黏膜下层层Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜

27、检查Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查早期胃癌（早期胃癌（型）：胃角上息肉样隆起，表面充血、糜烂、型）：胃角上息肉样隆起，表面充血、糜烂、伴有少许出血，活检示低分化腺癌，手术证实为黏膜内癌伴有少许出血，活检示低分化腺癌，手术证实为黏膜内癌Department of Gast

28、roenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查早期胃癌（早期胃癌（aa型）：胃窦后壁丘样隆起，型）：胃窦后壁丘样隆起，类圆形、表面少许糜烂，活检示印戒细胞癌类圆形、表面少许糜烂，活检示印戒细胞癌Department of GastroenterologyDepartment of GastroenterologyThe

29、First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查 早期胃癌（早期胃癌（型）：胃窦前壁溃疡，形不规则、边不整型）：胃窦前壁溃疡，形不规则、边不整基底覆以黄白苔，活检示黏膜内黏液细胞癌基底覆以黄白苔，活检示黏膜内黏液细胞癌Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengd

30、u Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查进展期胃癌进展期胃癌胃镜下表现：胃镜下表现：肿瘤表面凹凸不平，糜烂，有污秽苔肿瘤表面凹凸不平，糜烂，有污秽苔 深大溃疡、底部覆有污秽苔，溃疡边缘呈结节样隆起、深大溃疡、底部覆有污秽苔，溃疡边缘呈结节样隆起、无聚合皱襞，病变处无蠕动无聚合皱襞，病变处无蠕动 流出道狭窄流出道狭窄 皮革胃皮革胃Department of GastroenterologyDepartment of GastroenterologyThe First Affi

31、liated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查 Bormann Bormann分型法：分型法：型：息肉型，肿瘤向胃腔内生长隆起型：息肉型，肿瘤向胃腔内生长隆起 型：溃疡型，单个或多个溃疡，边缘隆起，与黏膜分型：溃疡型，单个或多个溃疡，边缘隆起，与黏膜分界清楚界清楚 型：又称溃疡浸润型，隆起而有结节状的边缘向四周型：又称溃疡浸润型，隆起而有结节状的边缘向四周浸润，与正常黏膜分界不清，最常见浸润，与正常黏膜分界不清，最常见 型：又称弥

32、漫浸润型，癌发生于黏膜表层之下，向四型：又称弥漫浸润型，癌发生于黏膜表层之下，向四周浸润扩散，伴纤维组织增生，少见。如累及全胃，则周浸润扩散，伴纤维组织增生，少见。如累及全胃，则胃变成一固定而不能扩张的小胃，称为皮革胃胃变成一固定而不能扩张的小胃，称为皮革胃(linitis(linitis plastica)plastica)Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospit

33、al of Chengdu Medical CollegeCollege胃镜检查胃镜检查Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查进展期胃癌（进展期胃癌（型）：胃体后壁球型）：胃体后壁球形隆起，表面糜烂不平、伴出血形隆起，表面糜烂不平、伴出血Department of Gastro

34、enterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查进展期胃癌（进展期胃癌（型）：胃角巨大癌性溃疡，型）：胃角巨大癌性溃疡，基底不平、厚苔，周边环堤样隆起基底不平、厚苔，周边环堤样隆起Department of GastroenterologyDepartment of GastroenterologyThe First Affi

35、liated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查进展期胃癌（进展期胃癌（型）：胃角类圆形溃疡，型）：胃角类圆形溃疡，基底不平结节状，病变向周边浸润基底不平结节状，病变向周边浸润Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated

36、Hospital of Chengdu Medical CollegeCollege胃镜检查胃镜检查超声内镜超声内镜 可较准确判断肿瘤侵犯的深度，有助于早期和进展期癌可较准确判断肿瘤侵犯的深度，有助于早期和进展期癌的区分的区分 可以了解有无局部淋巴结转移，作为可以了解有无局部淋巴结转移，作为CTCT的补充的补充Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Ch

37、engdu Medical CollegeCollege胃镜检查胃镜检查胃镜下胃镜下2.5cm隆起性包块，隆起性包块，EUS示局限于黏膜下层内的示局限于黏膜下层内的低回声，病理示腺癌低回声，病理示腺癌Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege实验室检查贫血贫血大便隐血阳性大便隐血阳性Departm

38、ent of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollegeX X线钡餐线钡餐表现表现龛影或充盈缺损，难以区分良恶性龛影或充盈缺损，难以区分良恶性黏膜皱襞破坏、消失或中断，临近胃黏膜僵直，蠕动消失，黏膜皱襞破坏、消失或中断，临近胃黏膜僵直，蠕动消失，胃癌可能性大胃癌可能性大Department of Gastroenterolo

39、gyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege诊断诊断胃癌的诊断主要依据胃镜检查加活检胃癌的诊断主要依据胃镜检查加活检对对中上腹痛中上腹痛、消化不良消化不良、呕血呕血或或黑粪黑粪者及时行胃者及时行胃镜检查镜检查对下列情况应定期胃镜检查：对下列情况应定期胃镜检查：慢性萎缩性胃炎伴肠化生或异型增生者慢性萎缩性胃炎伴肠化生或异型增生者 胃溃疡经正规治疗胃溃疡经正

40、规治疗2 2月无效月无效 胃大部切除术后胃大部切除术后1010年以上者年以上者Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege并发症出血出血多呈呕血或黑粪、多呈呕血或黑粪、5%5%可发生难治性大出血可发生难治性大出血贲门或幽门梗阻贲门或幽门梗阻进食困难、呕吐、腹胀及营养不良进食困难、呕吐、腹胀及营养不良

41、 穿孔穿孔 多见于幽门前区的溃疡型癌多见于幽门前区的溃疡型癌Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege治疗治疗早期胃癌早期胃癌没有淋巴结转移时，可采取没有淋巴结转移时，可采取内镜治疗内镜治疗进展期胃癌进展期胃癌没有全身转移时，行没有全身转移时，行手术治疗手术治疗肿瘤切除后，应尽可能清除残胃的肿瘤切

42、除后，应尽可能清除残胃的HpHp感染感染Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege治疗-内镜治疗内镜下黏膜切除术内镜下黏膜切除术 EMR EMR（endoscopic mucosal resection)endoscopic mucosal resection)内镜下黏膜剥离术内镜下黏膜剥离术 E

43、SD ESD（endoscopic submucosal dissection)endoscopic submucosal dissection)适用于高或中分化、无溃疡、直径小于适用于高或中分化、无溃疡、直径小于2cm2cm且无淋巴结转且无淋巴结转移者移者切除组织送病理检查，发现癌组织侵袭黏膜下层，需追加切除组织送病理检查，发现癌组织侵袭黏膜下层，需追加手术治疗手术治疗Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The

44、First Affiliated Hospital of Chengdu Medical CollegeCollege治疗-内镜治疗Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege治疗-手术治疗早期胃癌可采取胃部分切除术早期胃癌可采取胃部分切除术进展期胃癌如无远处转移，尽可能根治性切除进展期胃癌如无远处

45、转移，尽可能根治性切除伴有远处转移或伴有梗阻者，可行姑息手术伴有远处转移或伴有梗阻者，可行姑息手术Department of GastroenterologyDepartment of GastroenterologyThe First Affiliated Hospital of Chengdu Medical The First Affiliated Hospital of Chengdu Medical CollegeCollege治疗-化学治疗早期胃癌不伴有任何转移，术后一般不需要化疗早期胃癌不伴有任何转移，术后一般不需要化疗术前新辅助化疗可使肿瘤缩小、增加手术根治及治愈机会术前新辅助

46、化疗可使肿瘤缩小、增加手术根治及治愈机会术后辅助化疗术后辅助化疗 静脉化疗、腹腔内化疗、持续性腹腔温热灌注、淋巴靶向化疗静脉化疗、腹腔内化疗、持续性腹腔温热灌注、淋巴靶向化疗化疗药物化疗药物5-5-氟尿嘧啶、替加氟、丝裂霉素、阿霉素、顺铂、卡铂、亚硝脲类、氟尿嘧啶、替加氟、丝裂霉素、阿霉素、顺铂、卡铂、亚硝脲类、足叶乙甙足叶乙甙 结束语当你尽了自己的最大努力时，失败也是伟大的，所以不要放弃，坚持就是正确的。When You Do Your Best,Failure Is Great,So DonT Give Up,Stick To The End感谢聆听不足之处请大家批评指导Please Criticize And Guide The Shortcomings演讲人：XXXXXX 时 间：XX年XX月XX日