如何提高消化内镜中心早期胃癌检出率.ppt

* * Image 1: Upper esophagus image taken about 20 cm from the incisors to obtain a forward view of the esophagus. Image 2: 2 cm above the squamocolumnar junction (Z line).This endoscopic appearance is particularly important For confirming that a careful study of this area has been carried out,and to locate anomalies accurately,particularly In the case of esophagitis or Barrett’s esophagus. Image3:Cardia in inversion.An examination of the cardia in inversion allows visualization of the cardia and the totality 0f the upper part of the fundus ininversion. Image4:Upper part of the lesser curvature.This image provides good visibility after inflation of the upper part of the stomach(fundus). Image5:Angulus in partial inversion.Positioning the endoscope in front of the angulus provides confirmation that a complete examination of the antrum,angulus and fundus seen in version has been performed. Image6:Antrum. The whole of the antrum is visualized with this image,assuming that the angulus has just been examined as described above. Image7: Duodenal bulb. The image should be taken with the endoscope positioned on the bulbar side of the pylorus in order to see the entire bulb. Image8: Second part of the duodenum.This confirm that a complete examination has been performed, with the end of the endoscope positioned near the papillary area. * 然而，仅仅到达这些部位是不够的，要结合远近视野，多个观察角度仔细观察。 * * * * * * 凹陷性病变应分别在凹陷边缘的内缘四周及凹陷的基底部取材，浅凹病变主要取基底部；深凹病变主要取内缘，因外缘常为正常黏膜，而基底多有较厚的坏死组织。隆起型病变应分别在基底部及顶部取材。此外，为确定癌肿的浸润范围，为手术切除的范围提供依据，还应在距癌灶贲门侧3 cm（肿块型）、4 cm（溃疡型）、5 cm（浸润型）处取材1~2块，单独固定送检 * 如何提高胃早癌检出率 一、胃早癌诊治现状 我国是胃癌高发国家，每年死于胃癌患者超过16万，约占全部肿瘤死亡人数1/5。 胃癌患者于术后生存期的长短是评价其诊断水平的重要指标，而生存期的长短与胃癌分期密切相关。 胃癌早期病变的比例 近80% 日本 5%~10% 中国 早期识别癌前病变非典型性增生及原位癌是防止肿瘤发生、发展及早期诊断和治疗的重要环节 40% 晚期 95% 早期 五年生存率 二、诊断 如何发现和识别？ 意识 认识 观念 环境 设备 病理 科普 更智能的辅助技术 新内镜设备给我们带来了什么 更便捷的操作 更清晰的视野 设备重要，医生更重要 胃镜前准备 胃镜检查规范 规范早期胃癌的诊断程序 癌前状态的筛查与随访 胃镜前准备 胃内粘液的祛除 应用袪泡剂 及祛除粘液 时间 病人体位 减少病变遗漏 染色获得良好效果 西甲硅油 糜蛋白酶等 检查前20分钟 坐位---卧位 胃镜检查---观察部位的暴露规范 至少进行8个部位的多角度观察和图