重度反流性食管炎的X线造影表现特点

Characteristics of severe reflux esophagitis in X-ray esophagography

目的 探讨重度反流性食管炎的X线造影表现特点,以提高对该病的影像诊断水平.方法 回顾性分析伴有溃疡或狭窄的重度反流性食管炎32例,所有病例均经内镜活检或细胞学证实,其中11例经手术及病理证实.结果 32例中发生于食管下段27例（84.4%）,中下段4例（12.5%）,上段1例（3.1%）;病变长度1～4 cm,平均3.7 cm.黏膜不规则28例（87.5%）;黏膜呈小结节状或息肉状改变14例（43.8%）;合并食管溃疡16例（50%）.锥形狭窄13例（40.7%）,弧形狭窄12例（37.5%）,不规则结节状狭窄7例（21.9%）.病变与正常食管壁分界清楚及不清楚者各16例（50%）.假性憩室者8例（25%）,固定的横行黏膜纹4例（11.8%）,病变上端食管局限性囊袋样膨出9例（28.1%）.局部管壁柔软19例（59.4%）,僵硬13例（40.6%）.病变下缘累及贲门者5例,合并食管裂孔疝22例（71.9%）病例中病变下缘均累及膈上疝囊.结论 重度反流性食管炎的X线造影多表现为食管下段狭窄、溃疡,合并食管裂孔疝,如发现假性憩室、固定的横行黏膜纹及病变上端食管局限性囊袋样膨出等征象则有助于诊断.

Objective To discuss the characteristics of severe refulx esophagitis in X-ray esophagography and improve the diagnostic level. Methods Thirty-two cases of severe refulx esophagitis with ulcer and/or stricture were retrospectively reviewed. All cases were confirmed by endoscopic biopsy or cytology, of 11 cases were proved by surgery and pathology. Results Twenty-seven lesions （84.4%） located in the lower segment of esophagus, 4 （12.5 %） in the middle and lower segment, and 1 （3.1%） in the upper segment. Length of the lesions ranged in size from 1 to 4 cm, mean 3.7 cm. Radiologic features： irregular mucosal folds in 28 （87.5%）, small nodular or polypoidal mucosal pattern in 14 （43.8%）, esophageal ulcer in 16 （50%）. Esophageal stricture： tapered in 13 （40. 7%）, arc-like in 12 （37.5%）, irregular nodular pattern in 7 （21.9%） ; Transitional zone between lesion and normal mucosa of esophagus： clear in 16 （50%）, unclear in 16 （50%） ; intramural pseudodiverticula in 8 （25 % ）, Fixed transverse folds in 4 （11.8 % ）, sacculation in the superior extremity of the lesion in 9 （28. 1%）, Local esophageal wall was soft in 19 （59. 4%）, rigid in 13 （40. 6%）; Cardia involvement in 5 （15.6 %）, hiatal hernia in 22 （7l. 9 %）, all of which were involved. Conclusion In X-ray esophagography, severe refulx esophagitis mostly manifest as stricture and ulcer in the lower segment of esophagus with hiatal hernia. Signs of intramural pseudodivertlcula, fixed transverse folds and sacculation in the superior extremity of the lesion are helpful to make correct diagnosis.