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[目的]探讨在食管癌、胃癌均高发地区采用内镜对上消化道癌(食管癌、胃癌)联合筛查的价值。[方法]采用流行病学调查、血清胃蛋白酶原(PG)检测、内镜活检和病理检查同时进行的方法,对武威市凉州区40～69岁无症状,有上消化道病史、食管癌和胃癌家族史志愿者进行上消化道癌筛查。[结果]共筛查2005人,上消化道癌检出率0.65%(13/2005),其中食管癌0.15%(3/2005),胃癌0.50%(10/2005);早期食管癌检出率100.00%(3/3),早期胃癌检出率30.00%(3/10),进展期胃癌为70.00%(7/10);食管重度异型增生/原位癌、中度异型增生检出率分别为0.15%(3/2005)、0.20%(4/2005);胃高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.20%(4/2005)、12.62%(253/2005)、10.92%(219/2005)和19.50%(391/2005)。以PGⅠ≤70ng/ml,PGⅠ/Ⅱ≤7.0作为PG单筛胃癌临界值,PG阴性1280人(63.84%),阳性725人(36.16%);PG阳性者中胃癌检出率0.69%(5/725),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.28%(2/725)、16.69%(121/725)、16.00%(116/725)、22.34%(162/725);PG阴性者胃癌检出率0.39%(5/1280),高级别上皮内瘤变、低级别上皮内瘤变、肠上皮化生及萎缩性胃炎检出率分别为0.16%(2/1280)、10.31%(132/1280)、8.05%(103/1280)、17.89%(229/1280)。PG阳性与PG阴性的胃癌及其癌前病变检出率有显著性差异(P<0.01)。PG阴性1280人中,检出食管癌2例,重度异型增生/原位癌1例;PG阳性725人中,检出食管癌1例,重度异型增生/原位癌2例。[结论]在食管癌、胃癌高发区直接应用内镜对上消化道癌进行筛查,能最大限度降低上消化道癌的漏诊,使设备、技术、经费及卫生资源得到充分利用。
[Objective] To investigate the value of endoscopy combined with screening for upper gastrointestinal cancer (esophageal cancer and gastric cancer) in esophageal and gastric cancer-prone areas. [Methods] The epidemiological investigation, serum pepsinogen (PG) detection, endoscopic biopsy and pathological examination were performed at the same time. The prevalence of asymptomatic upper gastrointestinal tract, esophageal cancer And family history of gastric cancer volunteers for upper gastrointestinal cancer screening. [Results] The co-screening of 2005, the upper gastrointestinal cancer detection rate was 0.65% (13/2005), of which esophageal cancer 0.15% (3/2005), gastric cancer 0.50% (10/2005); early detection rate of esophageal cancer 100.00% (3/3) respectively. The detection rate of early gastric cancer was 30.00% (3/10) and that of advanced gastric cancer was 70.00% (7/10). The detection rates of severe esophageal dysplasia / carcinoma in situ and moderate dysplasia were (3/2005) and 0.20% (4/2005) respectively. The detection rates of high grade intraepithelial neoplasia, low grade intraepithelial neoplasia, intestinal metaplasia and atrophic gastritis were 0.20% (4 / 2005), 12.62% (253/2005), 10.92% (219/2005) and 19.50% (391/2005). PGⅠ≤70ng / ml and PGⅠ / Ⅱ≤7.0 were the thresholds of PG single-screen gastric cancer, PG negative 1280 (63.84%), positive 725 (36.16%); PG positive gastric cancer detection rate 0.69% 725). The positive rates of high grade intraepithelial neoplasia, low grade intraepithelial neoplasia, intestinal metaplasia and atrophic gastritis were 0.28% (2/725), 16.69% (121/725), 16.00% (116 /725),22.34%(162/725) .PG negative gastric cancer detection rate of 0.39% (5/1280), high-grade intraepithelial neoplasia, low-grade intraepithelial neoplasia, intestinal metaplasia and atrophic gastritis The rates were 0.16% (2/1280), 10.31% (132/1280), 8.05% (103/1280) and 17.89% (229/1280), respectively. PG positive and PG negative gastric cancer and its precancerous lesions were significantly different (P <0.01). PG-negative 1280 people, detected in 2 cases of esophageal cancer, severe dysplasia / carcinoma in situ in 1 case; PG positive 725, detected in 1 case of esophageal cancer, severe dysplasia / carcinoma in situ in 2 cases. [Conclusion] The screening of upper digestive tract cancer by direct endoscopy in esophageal cancer and high incidence area of gastric cancer can minimize the missed diagnosis of upper digestive tract cancer and make full use of equipment, technology, funds and health resources.