食管上段异位胃黏膜39例临床分析  

Clinical analysis of 39 cases of heterotopic gastric mucosa in the upper esophagus

作　　者：宋震亚[1] 黄宣[1] 钱可大[1] 彭佳萍[2] 孙爱武[3] 张奕荫[3] 赵振刚[3] 

机构地区：[1]浙江大学医学院附属第二医院消化内科,杭州310009 [2]浙江大学肿瘤研究所 [3]浙江省肿瘤医院内镜室

出　　处：《中华医学杂志》2005年第4期244-247,共4页National Medical Journal of China

摘　　要：目的分析食管上段异位胃黏膜的发病率、内镜及病理特征,探讨本病的临床意义。方法对2000年1月至2004年4月浙江大学医学院附属第二医院消化科和浙江省肿瘤医院内镜室连续行胃镜检查的15228例患者行临床研究。结果本组经病理确诊为食管上段异位胃黏膜有39例,占026%,平均年龄为50岁,其中18例患者有吞咽疼痛、咽喉部不适等临床症状。37例患者在胃镜下表现为平坦型,2例为息肉型。病理发现18例为胃体底腺型,7例为胃窦腺型,11例为交界腺型,大多数异位胃黏膜伴轻到中度炎症表现。其中幽门螺杆菌感染5例(128%),但与局部黏膜的炎症程度无相关性;14例合并有糜烂性胃炎(359%),1例合并有Barrett食管(26%),8例合并消化性溃疡(205%),发病率均明显高于无食管上段异位胃黏膜者(P<005)。结论食管上段异位胃黏膜并非罕见,在内镜下表现较特异,并且部分患者可有局部临床表现,对制酸剂敏感。并可出现狭窄等并发症。对有并发症、肠化、不典型增生的食管上段异位胃黏膜的患者应加强监测、定期随访。Objective To determine accurately the incidence of heterotopic gastric mucosa in the upper esophagus (HGMUE) in China, and to study the macroscopic and microscopic aspects of the lesions and to evaluate the clinical importance of HGMUE.Methods A prospective study was made among a total of 15 228 consecutive patients, 8 573 male and 6 655 female, aged 54 (8-95), undergoing gastroscopy. Disease histories of all patients were carefully inquired, especially those regarding possible complaints including discomfort of throat and swallowing pain and so on. Special care was taken in the upper esophageal sphincter area to make sure whether the area was adequately inspected. Biopsy specimens from aberrant mucosa were obtained and the sections were stained with haematoxylin and eosin, and Giemsa stain for Helicobacter pylori.Results HGMUE was found in 39 patients (0.26%) with an average age of 50. Five patients with H. pylori infection in heterotopic gastric mucosa also presented the infection in the stomach. The gastric mucosa was gastric body type in 8 patients, transitional type in 11 patients, and antral pattern in 7 patients. Intestinal metaplasia was found in 5 patients, and mild atypical hyperplasia in 2 patients. An impressive finding was coexistent erosive gastritis in 14 patients (35.9%) , Barrett′s esophagus in one patient (2.6%),peptic ulcer in 8 patients (20.5%), and a patient had the complication of constriction in the upper esophagus.Conclusion HGMUE is not rare in China. The presence of inlet patches is possibly correlated with specific symptoms. There are some severe complications in HGMUE, especially esophageal constriction. Close surveillance should be taken for rare cases with metaplasia or dysplasia in HGMUE.

关 键 词：异位胃黏膜 食管 患者 并发症 局部 内镜 发病率 合并 结论 医学院 

分 类 号：R571[医药卫生—消化系统]