食管末端及胃-食管连接处的肠化生、异型增生和肿瘤发病情况

Analysis of pathological lesions at distal esophagus and esophagogastric junction

目的 了解我国人食管末端和胃-食管连接处的肠化生（IM）及异形增生和肿瘤的发病状况,齿状线（SCJ）位置和反流性食管炎（RE）的关系。方法 调查记录391例患者的症状、胃镜下RE的表现、并根据SCJ的位置分为3组,其中,胃镜下见齿状线上移≥3cm为A组,<3cm为B组,齿状线和GEJ同一水平的为C组。每例患者均于齿状线远端活检送病理检查。结果A、B、C3组IM发生率分别为26.53％、33.85％、34.00％;IM的发生在40岁以后随着年龄增长逐渐增加,男女之间无差异;361例患者中共诊断异型增生12例（轻度7例、中重度5例）、贲门癌16例、食管腺癌1例;A、B、C3组RE的发病率分别为57.14％、22.83％、12.00％。结论 1.胃镜下提示为LSBE、SSBE和GEJ三组间的IM发生率无显著差异;2.应重视食管末端及胃-食管连接处异型增生的诊断;3.贲门癌发病远高于食管腺癌。

Objective To study the prevalence of intestinal metaplasia (IM) ,dysplasia and carcinoma at the distal esophagus and esophagogastric junctions as well as the relationship between SCJ and RE. Methods In 391 patients the main symptoms , RE and its degree by gastro endoscopy, and biopsy specimens from the mucosa just below SCJ were investigated. Results The prevalence of IM in LSBE,SSBE and GEJ is 26. 53% , 33.85% and 34.00% respectively; It increases with age after 40 years old and no difference occurs between' the male and female. ;12 cases of dysplasia were diagnosed ( low -grade 7 cases , medium and high-grade 5 cases) . Sixteen cases of cardia carcinomas and 1 case of esophageal adenocarcinoma were diagnosed; The longer the SCJ moved upward above GEJ, the higher the prevalence and severeness of RE . Conclusions 1. There is no difference about the prevalence of IM among LSBE,SSBE and GEJ; 2. It is important to pay attention to the diagnosis of dysplasia in the distal esophagus and esophagogastric junctions; 3. The prevalence of cardia carcinomas is much higher than that of esophageal adenocarcinoma.