Barrett食管的病理本质及其与返流性食管炎、食管腺癌关系的研究

Pathologic nature of Barrett's esophagus and its relationship to reflux esophagitis and adenocarcinoma of esophagus

从１０００例食管粘膜咬检及１５８０例食管贲门癌切除标本中交界处癌１６５例的形态学、粘液组化及ＦＣＭ分析，探讨ＢＥ病理本质及其与返流性食管炎、食管腺癌的关系。结果：１０００例咬检中２２７例有不同程度的返流性食管炎，其中３例符合ＢＥ。１５８０例食管贲门癌中，交界处癌２３例（１．５％）为食管腺癌，１３例（５６．５％）根据部位、形态、粘液组化分析证明为ＢＥ来源的腺癌。本文认为慢性胃液返流使食管粘膜鳞状上皮长期受损，修复中，部分病例食管鳞状上皮由邻接耐酸性较强、增殖更活跃的胃贲门上皮向上异位生长而代替。长期非特异性刺激附加致癌因素刺激下，修复性增生转变为渐进性异型增生，最终导致癌变，形成ＢＥ来源的腺癌。

cases of esophageal biopsies and 165 cases of resected carcinoma located in esophagocardiac junction selected from 1580 cases of esophageal and cardiac carcinoma were studied morphologically combined with analysis of DNA content by flowcytometry (FCM) and mucus histochemistry to investigate the pathologic nature of Barrett's esophagus (BE) and its relationship to reflux esophagitis and adenocarcinoma of esophagus. The results showed that among 1000 esophageal biopsies, 227 cases (22.7%) showed various degrees of reflux esophagitis in which 3 cases (1.32%) fulfilled the histologic criteria of BE.23 cases (1.5%) of esophageal adenocarcinoma were found in 1580 cases of esophageal and cardiac carcinoma among which 13 cases (56.5%) were proved to be adenocarcinoma originated from BE.This study supports the view that BE is an acquired lesion whose pathogenesis is closely related to the long-term repeated esophageal mucous membrane damage by reflux gastric juice and its repair processes, and in some cases the damaged squamous epithelium will be replaced by adjacent cardiac columnar epithelium being relatively acid resistant and with more proliferative potency through upward ectopic growth along eroded superficial esophageal mucosa. Longstanding nonspecific with the addition of carcinogenic stimulation may eventually induce canceration through sequential dysplasia which results in adenocarcinoma originated from BE.