Barrett食管临床及内镜特点与病理关系分析

The relationship of pathology and clinical,endoscopic characteristics in Barrett's esophagus

目的分析Barrett食管(Barrett’s esophagus,BE)临床症状、镜下表现及病理特点,并对BE黏膜发生肠上皮化生(IM)及异型增生的相关因素作初步探讨。方法回顾分析经胃镜下诊断的547例BE患者的临床和镜下特点,其中经病理确诊59例,分析其临床资料、胃镜表现、病理类型与IM及异型增生的关系。结果BE患者以男性居多,随年龄增长有增多趋势。部分患者存在不同程度的胃食管反流症状(GERD),少数患者镜下有反流性食管炎(RE)表现。黏膜形态以岛状型多见,柱状上皮长度以短段为主。病理类型以胃底型及贲门型多见,显著高于特殊肠化生型。肠化生型BE上皮异型增生发病率显著高于另外两种病理类型。IM及异型增生在两性别间的发病率无统计学差异,30岁以上发病率显著高于30岁以下组。长段BE的IM及异型增生发生率高于短段BE,全周型及舌型发生率高于岛状型,但均无显著性差异。结论BE多发于男性、年长患者,是独立于RE及GERD的疾病。BE镜下以短段、岛状型多见。肠上皮化生少见,但此种类型的异型增生率高,是癌变的危险因素,需提高其检出率。

Objective To analyze the clinical, endoscopic and pathological characteristics of Barrett＇ s esophagus （BE）, and to elementarily probe the factors associated with the intestinal metaplasia （IM） and dysplasia. Methods The clinical and endoscopic characteristics of 547 BE patients who were diagnosed by endoscope and pathology were reviewed. Among them, 59 cases were comfirmed by pathology, whose common data, endoscopic represent, pathological types and the relationship with IM and dysplasia were analyzed. Results The patients of BE were mainly male and it tended to increase with the age increasing. Part of the patients had gastroesophagael reflux disease （GERD） of different degrees, and only a few had the present of reflux esophagitis （RE）. Under endoscope, the island-type BE was the most and the length of the columnal epithelium was mostly short-segment. The pathologic types were mainly fundus-type and cardia-type, which were significantly more than the specialized intestinal metaplasia type. However, the incidence of dysplasia in the specialized intestinal metaplasia type was significantly more than that of the others. The incidences of IM and dysplasia were not statistically different between the sexes, while they were significantly greater in the groups with the patients who were older than 30. The incidences of IM and dysplasia tended to be higher in long-segment BE than that in short-segment BE, in circumferential-type and linguiform-type than those in island-type. However, the differences were not significant. Conclusion BE is more common in male and the older, and BE is a disease independent from RE and GERD. Most of BE are SSBE and island-type. The incidence of IM is low, but it is a risk factor of cancer, so the detection rate should be improved.