Barrett食管的内镜与病理特征分析

Endoscopic and pathological characteristics of Barrett＇s esophagus

目的探讨Barrett食管（BE）的病理和内镜特点。方法对152例经胃镜榆查并经病理检查证实的BE患者资料进行回顾性分析、总结。结果BE患者以40—60岁居多。临床症状有不同程度重叠，烧心反酸51．32％（78／152）、吞咽困难5．92％（9／152）、胸骨后疼痛7．89％（12／152）、上腹痛或不适44．08％（67／152），无症状者5．26％（8／152）。内镜下表现为LSBE者7例（4．61％）、SSBE者145例（95．39％）。可见岛型98例，占64．47％；舌型39例，占25．66％；全周型15例，占9．87％。病理检查152例食管下段复层鳞状上皮均被柱状上皮取代，68例（44．74％）有肠化。结论BE多见于中年人，临床无特殊表现，诊断依靠内镜和病理检查，以岛型多见，但岛型肠化率最低，年龄与肠化相关，伴异型增生和肠化患者应加强随访以防止癌变。

Objective To investigate the endoscopic and pathological characteristics of Barrett＇s esophagus （BE）. Methods Data of 152 patients who were diagnosed as having BE with endoscopy and pathology were retrospectively analyzed. Results BE was most commonly seen in patients of 40-60 years old. The clinical manifestations overlapped in different patients, including regurgitation and heartburn in 78 （51.32% ） , dysphagia in 9 （5.92%） , retrostemal pain in 12 （7.89%） , upper abdominal pain or discom- fort in 67 （44. 08% ） , and asymptomatic in 8 （5.26%）. Long segment BE （LSBE） was determined in 7 patients （4. 61% ）, and short segment BE （SSBE） in 145 （95.39%）. The metaplasia pattern under endoscopy included island like in 98 （64.47%）, tongue like in 39 （25.66%） and circumferential in 15 （9. 87% ）. Stratified squamous epithelia in the lower part of the esophagus were replaced by columnar epithelia in all cases, and intestinal metaplasia occurred in 68 cases （44. 74 % ）. Conclusion BE is most frequently seen in the middle-aged and can be diagnosed by endoscopy and pathology without special clinical manifestations. Island pattern occurs in most cases and is with lowest rate of intestinal metaplasia, which is associated with age. Patients with specialized intestinal metaplasia and dysplasia should be followed up for surveillance of cancer.