食管良性病变病理和预后的研究

Pathology and Prognosis of Esophageal Benign Lesions

目的探讨食管良性病变病理组织学类型和鳞癌及重度异型增生的发生率。方法对1997～2000年131例食管良性病变患者进行内镜形态观察与活检病理学检查,另取同期内镜检查食管正常者236例作为对照组。比较病理组织学变化,随访至2004年底,比较两组食管鳞癌和重度异型增生的发生率及相对危险度(RR)。结果食管良性病变根据内镜形态分为炎症糜烂型病变69例,平坦凹陷型病变21例和隆起型病变41例。病理组织学检查:正常或炎症上皮33例(25.19%),良性增生58例(44.27%)和轻中度异型增生40例(30.54%);对照组中,正常上皮181例(76.69%),良性增生55例(23.31%),无异型增生者。食管良性病变组中良性增生和轻中度异型增生明显高于对照组,而正常或炎症上皮明显低于对照组。食管良性病变组随访708人/年,鳞癌和重度异型增生分别发生21例和14例,共35例(4.94%)。对照组随访1315人/年,鳞癌和重度异型增生各发生1例,共2例(0.15%),食管良性病变组明显高于对照组。在食管良性病变中,良性增生和轻中度异型增生者鳞癌和重度异型增生发生率明显高于正常或炎症上皮。结论含有良性增生和轻中度异型增生的食管良性病变是食管鳞癌癌前状态。

Objective To investigate the pathohistology and the incidence of squamous carcinoma and severe dysplasia in esophageal benign lesions. Methods The endoscopic appearance and pathohistologic feature were observed in 131 cases with esophageal benign lesions during 1997 ~ 2000 ,at the same time 236 cases with normal esophagus endoscop as control group. Two groups were followed up to the end of 2004. The pathohistologic feature and the incidence of squamous carcinoma and severe dysplasia between two groups was compared ,and the relative risk（RR） was computed. Results Esophageal benign lesions were divided endoscopically into three types ： inflammatory erosive type （ 69 cases）, superficial or ex- cavated type（21 cases） and protruded type（41 cases） ,and pathohistologically,into normal（inflammatory）epithelium（33 cases,25.19% ） ,benign hyperplasia（58cases,44.27% ） and mild to moderate dysplasia （40 cases, 30.54% ）. In control group 181 cases with normal epithelium （76. 69% ） ,55 cases with benign hyperplasia （23.31% ）and no dysplasia were observed. The rate of detection of benign hyperplasia and mild to moderate dysplasia was higher in benign lesions group than in control group ,but normal epithelium was lower in benign lesions group than in control group. The follow-up person years of esophageal benign lesions group were 708 ,cases with esophageal squatmous carcinoma and 14 cases with severe dysplasia occurred during follow-up period, the total person year incidence rate （ incidence density）was 4.94%. The follow-up of control group were 1 315 ,one with esophageal squamous carcinoma and one with severe dysplasia occurred,the total incidence rate was 0. 15%. The esophageal benign lesion group was higher than control group. In esophageal benign lesions, the incidence of carcinoma and severe dysplasia in benign hyperplasia and mild to moderate dysplasia was higher than in normal （inflammatory） epithelium. Conclusion The esophageal benign lesions with benign hyperplasia and mild to moderate dysplasia are pre-cancerous conditions of esophageal squamous carcinoma.