Barrett食管诊断标准问题的探讨  

The Study of Diagnostic Criteria of Barrett's Esophagus

作　　者：熊理守[1] 崔毅[1] 王锦萍[1] 王锦辉[1] 薛玲[1] 胡品津[1] 陈旻湖[1] 

机构地区：[1]中山大学附属第一医院消化内科,广州510080

出　　处：《中国消化内镜》2008年第11期33-36,共4页Digestive Disease and Endoscopy

摘　　要：目的目前关于Barrett食管(BE)的内镜和病理组织学标准存在不同的观点,本研究旨在采用不同的诊断标准定义BE,从而探讨国人中BE的诊断标准问题。方法以内镜下疑似BE的患者为研究对象,进行病理组织学检查。研究前统一内镜下鳞柱状上皮交界处和胃食管结合处内镜检查标志的判断标准。内镜下疑似BE是指胃食管结合处的近端出现橘红色柱状上皮,即鳞柱状上皮交界处与胃食管结合处分离。食道粘膜活检取材使用四象限活检法,病理标本使用H&E染色,观察柱状细胞和特殊肠化上皮,同时观察BE的不典型增生情况。结果共收集到内镜下疑似BE者共209例,其中长段BE4例、短段BE205例;在209例内镜下疑似BE者中,食管远端共检出存在柱状上皮化生者171例;同时检出特殊肠上皮化生即病理发现杯状细胞者21例,检出率为10.0%(21/209);在21例特殊肠上皮化生患者中,长段BE1例、短段BE20例;仅1例发现不典型增生。结论BE的诊断需根据内镜检查和食管黏膜活检,可能以组织学上发现特殊肠化上皮为准更合适。Objective：There is discrepancy in the diagnostic criteria of Barrett＇s esophagus （BE） in the endoscopic and autopsy studies. This study is to explore diagnostic criteria of BE in Chinese patients undergoing endoscopy for upper gastrointestinal symptoms in our center. Methods： The following landmarks were identified： the squamo-columnar junction （SCJ）; the esophagus-gastro junction （EGJ）, defined as the proximal end of the gastric folds where the tubular esophagus meets the stomach. BE was searched with endoscopy when a suspected columnar-lined esophagus （CLE） was identified based on salmon-pink mucosa in either circumferential upward shift of the SCJ or in adjacent mucosal tongues or island. In the cases of circumferential segments, biopsy samples were taken from each of 4 quadrants at least every 2 cm. Samples were fLxed in 4% buffered formalin. Slides were stained using hematoxylin-erosin, and then examined by experienced pathologist. Results： A total of 209 patients were suspected to have CLE. Four of them （0.2%） were LSSB. Among 209 patients of suspected CLE, 171 were found to have columnar metaplasia of esophagus. Of 209 patients, SIM were found in 21 cases （15 men and 6 women）. Only 1 LSBE occurred in these 21 cases. One of 21 cases had low-grade dysplasia. Condusion： The diagnosis of BE should rely onthe endoscopic findings, and required histologically conrirmed intestinal metaplasia in the distal esophagus.

关 键 词：BARRETT食管 诊断 内镜 

分 类 号：R571[医药卫生—消化系统] R57[医药卫生—内科学]