短节段Barrett食管与贲门肠上皮化生的内镜与病理探讨  

Endoscopic and histological study on short-segment Barrett’s esophagus and cardia intestinal metaplasia

作　　者：常英[1] 龚均[1] 刘斌[2] 张军[1] 戴菲[1] 万小龙[1] 汪涛[1] 

机构地区：[1]西安交通大学第二医院消化内科,陕西西安710004 [2]陕西省人民医院急诊外科,陕西西安710068

出　　处：《第四军医大学学报》2004年第11期1009-1011,共3页Journal of the Fourth Military Medical University

基　　金：卫生部临床学科重点项目 (2 0 0 1 2 1 30 )

摘　　要：目的 :对比研究短节段Barrett食管 (SSBE)与贲门肠上皮化生 (CIM)内镜及病理学特点 ,探讨它们与胃食管反流病(GERD)及胃内炎症的关系 .方法 :对 32例SSBE和 4 1例CIM患者自食管远端、贲门、胃窦取 8块活检 ,经HE ,AB PAS ,AB HID及Giemsa染色行病理组织学检查 .结果 :SSBE组平均年龄低于CIM组 (P <0 .0 1 ) .SSBE组异型增生、不完全肠化发生率分别为 1 2 .5 %和 6 5 .6 % ,均明显高于CIM组的 2 .4 %和1 9.5 % (P <0 .0 1 ,P <0 .0 1 ) .SSBE和CIM组在反流症状、内镜下反流性食管炎 (RE)症改变及组织学上相比较差异有显著性 (P <0 .0 1 ) ,前者明显高于后者 .SSBE组HP感染及胃窦肠化发生率低于CIM组 (P <0 .0 5 ,P <0 .0 1 ) .结论 :内镜下疑诊SSBE时异型增生发生的危险性比CIM明显增高 ,提示它们具有不同的临床过程 .SSBE可能与GERD相关 ,而CIM可能与H .AIM: To investigate the endoscopic and histological characteristics of short segment Barrett’s esophagus (SSBE) and cardia intestinal metaplasia ( CIM) and their associations with Helicobacter pylori gastritis and gastro esophageal reflux disease (GERD). METHODS: Eight biopsy specimens taken from lower esophagus, cardia and gastric antrum in 32 cases of SSBE and 41 cases of CIM were stained with haematoxylin/eosin (HE), alcian blue/periodic acid Schiff (AB PAS), alcian blue/high iron diamine (AB HID) and Gimenez, respectively. RESULTS: It was found that the SSBE patients were younger than the CIM patients ( P <0.01). The incidence of dysplasia and incomplete intestinal metaplasia in SSBE patients was higher than that in the CIM patients( P <0.01, P <0.01). Compared with the CIM patients, the incidence of reflux symptomatic, endoscopic, or histological markers of GERD was higher in SSBE patients ( P <0.01), whereas the incidence of H.pylori infection and antral intestinal metaplasia was lower in SSBE patients ( P <0.05, P <0.01). CONCLUSION: The dysplasia risk is significantly higher in SSBE patients than in CIM patients, indicating two potentially different clinical processes of the two diseases. CIM is a manifestation of H. pylori infection associated with gastritis and multifocal atrophic gastritis, while SSBE may result from GERD.

关 键 词：内窥镜术 BARRETT食管 贲门肠上皮化生 胃食管连接处 

分 类 号：R322.4[医药卫生—人体解剖和组织胚胎学]