食管上段异位胃黏膜的组织学特点及临床意义  

Histological features and clinical significance of heterotopic gastric mucosa in upper esophagus

作　　者：陶林[1] 樊丽琳[1] 刘海燕[1] 沈小春[1] 闫庆军[1] 兰春慧[1] 王军[1] 李宁[1] 傅鑫[1] 赵敦勇[1] 刘卉[1] 刑寒阳[1] 张艳梅[1] 李丽[1] 杨均[1] 肖潇[1] 樊玲[1] 潘大维[1] 颜綦先[1] 敖兴[1] 李平[1] 牟江洪[2] 肖华亮[2] 陈东风[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所消化内科,重庆400042 [2]第三军医大学大坪医院野战外科研究所病理科,重庆400042

出　　处：《第三军医大学学报》2013年第9期905-909,共5页Journal of Third Military Medical University

摘　　要：目的观察食管上段异位胃黏膜(heterotopic gastric mucosa in upper esophagus,HGMUE)的组织学特点以及内镜下表现,研究患者各相关临床症状与HGMUE泌酸功能之间的联系。方法分析40例普通内镜下诊断为HGMUE的患者的临床表现、NBI内镜以及共聚焦激光显微内镜(confocal laser endomicroscopy,CLE)特点,采用透射电镜、HE、免疫组化观察其病理学特征。结果 40例患者中,平坦型38例(95%),隆起型2例(5%),病变形态有椭圆形18例(45%)、圆形9例(22.5%)、不规则岛状7例(17.5%)、条索状6例(15%);NBI内镜下,可清楚区分病变区域与周围正常食管黏膜,小凹形态以管状(92.5%)为主,未发现表面微血管扩张变异;CLE扫描腺管开口呈胃底型27例,非胃底型13例,结合HE病理诊断,符合率为92.5%,有不同程度的荧光素钠渗出;透射电镜显示细胞超微结构与正常胃黏膜无明显差异,HE染色胃底型腺体28例(70%),非胃底型腺体12例(30%);免疫组化结果显示,胃底型腺体中质子泵、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ表达均为阳性;相关临床症状中除胸骨后疼痛与壁细胞有关外(P<0.05),其余症状壁细胞均无统计学差异(P>0.05)。结论 HGMUE患者病理分型以胃底型为主,此种异位胃黏膜可能有分泌胃酸及胃蛋白酶的能力,与患者胸骨后疼痛的症状相关;NBI内镜及CLE对于HGMUE的诊断比普通内镜可能具有更好的分辨效果及价值。Objective To investigate the histological characteristics and endoscopic features of heterotopic gastric mucosa in upper esophagus （ HGMUE ）, and explore the correlation between the clinical symptoms and acid secretion of the patches. Methods The clinical manifestations, narrow band imaging （NBI） endoscopy and confocal laser endomicroscopy （CLE） characteristics of 40 cases of HGMUE patients diagnosed by common endoscopy in our department from March to November 2011 were retrospectively collected and analyzed. Transmission electron microscopy, HE staining, immunohistochemical assay was used to observe pathological features. Results In 40 patients, flat type was in 38 cases（95% ）, and 2 cases were with elevated type（5% ）. Lesion morphology with oval shape was found in 18 cases （45%）, 9 cases （22.5%） with round, irregular island in 7 cases （ 17.5% ）, and cords in 6 cases （ 15% ）. NBI endoscopy clearly distinguished the lesion and surrounding normal esophageal mucosa. Pits were mainly tubular （92.5%）. No surface microvascular dilatation was observed. CLE scanning showed fundic type in 27 cases, with a coincidence rate of 92.5% when combined with HE pathologic diagnosis. The patches had different degrees of sodium fluorescence exudation. Transmission electron microscopy showed no significant difference between ectopic gastric mucosa and normal gastric mucosa in cell ultra-structure. HE staining showed fundic type gastric mucosa in 28 cases （70%）, and non-fundic type in 12 cases （30%）. Immunohistochemical assay displayed that proton pump,pepsinogen Ⅰ , and pepsinogen Ⅱ were all positively expressed. In the symptoms associated with HEMUE, retrosternal pain related to the presence of parietal cells （ P 〈 0.05 ）, but others did not （ P 〉 0.05 ）. Gonclusion Most of the topic gastric mucosa in HGMUE are fundic type gastric mucosa, which secretes gastric acid and pepsin, and directly related to the symptoms of retrosternal pain. NBI endoscopy and CLE have better

关 键 词：HGMUE NBI 共聚焦激光显微内镜 组织学 

分 类 号：R322.43[医药卫生—人体解剖和组织胚胎学] R322.44[医药卫生—基础医学]