贲门癌根治术后返流性食管炎粘膜扫描电镜观察

Scanning electron microscopic observation of esophageal mucosa in patients with reflux esophagitis after resection of cardiac cancer

为探讨返流性食管炎粘膜改变，采用扫描电镜的方法，对贲门癌切除术后病人食管粘膜与正常人作对比观察。结果：正常食管粘膜细胞的更新呈程序性死亡，即凋亡；而返流性食管炎则表现为粘膜细胞泡样水肿、团状脱落、甚至细胞穿孔。提示：返流性食管炎可直接引起食管粘膜上皮细胞的变性、脱落及细胞膜微嵴紊乱和炎性水肿，此种改变与正常人食管粘膜上皮细胞凋亡完全不同。

Gastroesophageal reflux is frequently encountered after resection of cardiac cancer with esophagogastric anastomosis. The aim of this study was to observe the morphologic changes in esophageal mucosa of patients with reflux esophagitis by scanning electron microscopy and the findings were compared with those of normal human beings. Methods: Five patients with cardiac cancer resected 1,3 and 5 years before and 2 normal volunteers were observed. Biopsies were endoscopically made on posterior wall 5 cm above the anastomosis, and on postesior wall 5 cm above lower esphageal sphincter in normal persons for control. The samples were treated following the routine of electron microscopy. Results: Renewal of normal esophageal mucosal cells assume the form of programmed cell death, i.e apoptosis, while the esophageal mucosal cells in reflux esophagitis showed bleboid oedema, conglomerate exfoliation, or even cellular perforation. Conclusion: Degeneration, exfoliation of esophageal mucosal epithelial cells, and derangement of microfold and inflammatory oedema of cellmembrane may be directly caused by reflux esophagitis. This changes are completely different compared with the findings in normal persons and are the same in various periods postoperatively.