不同人种食管切除术后残余食管黏膜反流性损伤的比较研究  

Comparison of mucosal reflux damage in remnant esophagus after esophagectomy and gastric ;interposition between Chinese and Canadian population

作　　者：袁勇[1] DuranceauAndre 陈龙奇[1] 胡杨[1] 赵雍凡[1] 

机构地区：[1]四川大学华西医院胸外科,成都610041 [2]加拿大蒙特利尔大学医学中心胸外科

出　　处：《中华胃肠外科杂志》2015年第9期871-874,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（30770982）;四川省科技厅-国际合作项目（2013HH0060）

摘　　要：目的：探讨中国患者与加拿大患者在相似的胃食管反流情况下行食管切除胃食管吻合术后残余食管黏膜损伤的差异。方法前瞻性纳入2010年9月至2013年10月分别于加拿大蒙特利尔大学医学中心及四川大学华西医院行食管切除胃代食管术后的加拿大高加索人群及中国汉族人群，并按照完全相同的手术方式进行1∶1配对研究。比较两组患者术后反流情况，评估两组内镜下食管黏膜损伤程度（MUSE分级标准），并进行病理检测及食管上皮细胞增生指数检测。结果共纳入食管切除术后的加拿大及中国患者各18例，术后随访时间为45（28～67）月。两组患者术后明显反流症状出现率及评分、反流性食管炎的发生率以及内镜下所见的黏膜糜烂、溃疡及狭窄的发生率间比较，差异均无统计学意义（均P＞0．05）。而加拿大患者黏膜化生发生率[44．4％（8／18）比11．1％（2／18），P＝0．026]，MUSE食管黏膜损伤评分[1．5（1．0～2．0）比1．0（0～2．0），P＝0．042]及食管上皮细胞增生指数[0．40（0．30～0．45）比0．35（0．30～0．50），P＝0．038]均明显高于中国患者。结论在相似的胃食管反流情况下，加拿大患者的食管黏膜对胃食管反流的不良刺激较中国患者更为敏感，食管黏膜损伤更为严重。Objective To compare the difference of mucosal damage in the remnant esophagus with similar postoperative reflux after esophagectomy and gastric interposition between Chinese and Canadian population. Methods A prospective 1∶1 paired study based on the same surgical approach was performed in Medical Centre of University of Montreal and West China Hospital of Sichuan University during the period from September 2010 to October 2013. The patients were followed up and evaluated by reflux symptom scoring, endoscopic assessment of mucosal damage, pathologic examination of biopsies and proliferation index test of esophageal epithelium. Results Eighteen Han Chinese and 18 Caucasian Canadian patients with esophagectomy and gastric interposition were included in this study , with a follow-up period of 45 （28-67） months. There were no significant differences between the two groups in the incidence of postoperative reflux symptom, reflux symptom scoring, histological reflux esophagitis, erosion or stricture of remnant esophagus （all P〉0.05）. However, the incidence of mucosal metaplasia [44.4%（8/18） versus 11.1%（2/18）, P=0.026], quantitative MUSE scoring [1.5（1.0-2.0） versus 1.0 （0-2.0）, P=0.042] and proliferation index [0.40 （0.30-0.45） versus 0.35 （0.30-0.50）, P=0.038] of esophageal epithelium were significantly higher in Canadian patients than those in Chinese patients. Conclusion Under similar reflux situation, esophageal mucosa of Canadian population is more sensitive＆amp＇ to the gastroesophageal reflux damage compared with Chinese population , resulting in more severe reflux damage of remnant esophagus in Canadian patients.

关 键 词：食管 黏膜损伤 胃食管吻合术 胃食管反流 

分 类 号：R735.1[医药卫生—肿瘤]