, () - . . , . .
1) (, EGD esophagogastroduodenoscopy), . ( , 2 , , , ..) 70% [2]. 70-80%, 65-85%. [12, 13, 14, 15]. , , 95%, 99,5% [16]. 15-25% [17]. . , 100% . , . , [18, 19]. (u-EGD ultrathin EGD) 5,5 . (conventional EGD) . - , . , [20, 21]. (chromoscopy), . , , , , , . 91% [22]. (zoom-endoscopy, magnifying endoscopy) , 100- . [23, 24]. (NBI narrow band imaging) , . , -, , . NBI 89%, 93% [25]. MBI (multi band maging), FICE ( Fuji Intelligent Color Enhancement) OBI (optimal band imaging). . [26]. [27]. NBI MBI [28]. NBI 70%, 85%, 80% [13, 29].
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2) (confocal laser endomicroscopy), 1000- [30]. . . , 84%, 95%. . [31].
3) , , , (, ESG endosonography). . , 5 . 80%, 88-92%, 60-85%. , [32, 33, 34]. 88% 100%, N1 ( TNM) 58% 87%, . 73%, 88% [35]. (3D-, 3D-EUS). 100% [36].
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4) . ( ) , , , (, ). , , . , , 23%, 1518% [4,10,15,17]. . , , , 5 . 90%. ( )
5) (-, EUS-FNA endoscopic ultrasound-guided fine-needle aspiration) . - , . . - , - , 90-98% [37]. 85-93% 93-100%, , , (49-99% 33-99%, ) [33].
6) . , 25%. , . 12 , . , (, 12 ). (linitis plastica) .
7) () , . . , , , . (, CT computer tomography) . . 36-69% 83-92%, , 20-56%. 48-70%, 43-66% [41, 42, 43, 44].
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8) (MDCT multi-detector computer tomography) (virtual gastroscopy), 78-84% [42]. 89%, 78% [41, 43]. (, , , .). 90 100%, [45].
9) - (, PET positron emission tomography) (), - . 18F-2--2--D- () [46]. . - 26% [47]. , . , . [48, 49].
10) - (, MRI magnetic resonance imaging), , , . 54-85% 50-100%, [39]. 82%. [50].
11) , , ( , ) , ( ) , ( ). ( ), , , , , . , .
12) . , . (), 199, . .
(Japanese Research Society for Gastric Cancer) , , (. 1 2):
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. 1. J.R.S.G.C.
. 2. J.R.S.G.C.
1 - ;
2 ;
3 ;
4 ;
4s ;
4d ;
5 ;
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8 ;
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110 ;
111 .
4 . (N1): (16). (N2): (7), (8), (9), (10), (11). (N3): (12), (13), (14). (N4): (15), (16). N1N2, 12 ( ) , N3N4 . , . , , (skipping) , .
, : T1 , 2 , 3 , 4 . , ( ) 2 , , . N : 1 6 N1, 7 15 N2, 15 N3. , , , . D1 ( dissection) , (N16), D2 N16, (N9) (N7), (N8), (N11), (N3). D3 (N12), (N13), (N14), (N15), , (N16). IV (, 2001 ) D2 , , . , D2 27 , D3 40 . , , D2, ( ) .
10 (EMR endoscopic mucosal resection). EMR ( ): ; IIa (superficial elevated type) 2 IIc (superficial depressed type) 1 , ; . D2. , EMR [18,26,27].
, , . , , . , 1535%. , . , N1 ( 16) D2, N2 ( 111) D3. , D2 II IIIa . D3 .
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(, , , , , ). , , , [21]. D2 . , , , , , . . , 2 . . ( Appleby), , , , , , (left upper abdominal evisceration) ..
. 2000 , J.R. Siewert. , Z, . : . 30%, 10% [21]. , , . , .
, , , , ( ), , ( ) . , , . . , , , . . , . .. , , , , . , (, , , ), , . , , , .
. , , . , . , , , , .. . 3040%. PF ( 5), ELF (, 5), ECF (, 5). : , , .. , , , , , , . . . , . 10 , .
ASCO 2003 , , .
. . , , , , , . , . , , . , . ( , , ..) . , , . . . . () D2.
1. .., : , 30- / .., .. -, .., .., .. . / . , .: , - 2002, - 1, - . 25-28.
2. Crew K.D., Neugut A.I. Epidemiology of gastric cancer // World J Gastroenterol. 2006. Vol. 12, 3. P. 354-362.
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4. Rothenberg M.L. (Җ11): . The Oncologist, 2001:6;6680.
5. Parkin D.M. Global cancer statistics in the year 2000 // Lancet oncol. - 2001.- vol. 2 Sept. - P. 533- 543.
6. Hamashima C., Shibuya D., Yamazaki H. et al. The Japanese guidelines for gastric cancer screening // Jpn J Clin Oncol. 2008. Vol. 38. 4. P. 259-267.
7. Kaise M., Kato M., Urashima M. et al. Magnifying endoscopy combined with narrow-band imaging for differential diagnosis of superficial depressed gastric lesions // Endoscopy. 2009. Vol. 41, 4. P. 310-315.