摘要目的:探讨同时性多发性早期胃癌(synchronous multiple early gastric cancer，SMEGC)的临床、内镜和病理特征，以期减少漏诊率。方法:2017年1月—2019年12月在上海交通大学医学院附属松江医院行内镜黏膜下剥离术和(或)手术治疗，经术后病理证实早期胃癌的227例病例纳入回顾性分析，其中单发早期胃癌(solitary early gastric cancer，SEGC)200例(SEGC组)、SMEGC 27例(SMEGC组)，对比分析2组的临床、内镜和病理特征，并对SMEGC主、副病灶内镜病理特征进行关联性分析。结果:27例SMEGC共58个病灶，其中25例为术前同时发现的病灶，2例为内镜黏膜下剥离术后6个月内复查发现的与前一病灶不同部位的病灶。2组对比分析发现，SMEGC组中男性占比[85.2%(23/27)比61.5%(123/200), χ2＝5.815， P＝0.016]、癌旁组织萎缩伴肠化占比[96.3%(26/27)比81.0%(162/200), χ2＝3.912， P＝0.048]均高于SEGC组，患者年龄大于SEGC组[(68.7±6.7)岁比(63.8±9.8)岁， t＝-2.561， P＝0.011]。SMEGC组内关联性分析发现：主、副病灶在癌灶大小( r＝0.640， P<0.001)、垂直方向分布( r＝0.518， P＝0.006)、内镜大体形态( r＝0.904， P<0.001)和浸润深度( r＝0.470， P＝0.013)方面均有明显相关性。 结论:SMEGC好发于有萎缩性胃炎伴肠化背景的老年男性患者，当内镜检查发现1个早期癌灶时，需警惕多癌灶存在的可能，尤其是垂直方向同一分布范围内在大体形态和浸润深度方面与检出癌灶相同或相近的病灶。

abstractsObjective:To investigate the clinical, endoscopic and pathological characteristics of synchronous multiple early gastric cancer (SMEGC), and to reduce the rate of missed diagnosis.Methods:Clinical data of 227 early gastric cancer patients treated by endoscopic submucosal dissection (ESD) and/or surgery in Songjiang Hospital, Shanghai Jiaotong University School of Medicine from January 2017 to December 2019 were retrospectively analyzed. The differences of clinical, endoscopic and pathological characteristics between solitary early gastric cancer (SEGC) group (200 cases) and SMEGC group (27 cases) were compared. The relevance of endoscopic and pathological features of major and minor lesions of SMEGC was also analyzed.Results:Among the 227 early gastric cancer patients, 27 (11.9%) were SMEGC (58 lesions), of which 25 cases were detected preoperatively, and 2 cases were reexamined within 6 months after surgery with another lesion found at a different site from the previous lesion. In the SMEGC group, the percentages of male and atrophy and intestinal metaplasia in surrounding mucosa were significantly higher than those of the SEGC group [85.2% (23/27) VS 61.5% (123/200), χ2=5.815, P=0.016; 96.3% (26/27) VS 81.0% (162/200), χ2=3.912, P=0.048]. The mean age of the SMEGC group was significantly higher than that of the SEGC group (68.7±6.7 years VS 63.8±9.8 years, t=-2.561, P=0.011). The correlation analysis showed a significant correlation between the major and minor lesions of SMEGC in the size of lesion ( r=0.640, P<0.001), vertical location ( r=0.518, P=0.006), macroscopic type ( r=0.904, P<0.001) and depth of invasion ( r=0.470, P=0.013). Conclusion:SMEGC is prevalent in elderly males with atrophic gastritis and intestinal metaplasia. It is necessary to be alert to the possibility of multiple cancer lesions, if an early cancer lesion is found under endoscopy, especially those that may have the same or similar shape and invasion depth in the same vertical distribution range.