Barrett食管内镜临床特点分析及与反流性食管炎的关系

目的研究Barrett食管（BE）内镜下表现和临床特点及与反流性食管炎（RE）的关系。方法按新标准诊断BE和RE,研究BE内镜下分型与特点及病理结果,分析BE的发病情况、临床表现、H·pylori感染情况及与反流性食管炎的关系。结果BE占胃镜受检人数的7．61％,男女之比为1：41,只有18．71％有典型的返流症状;RE的检出率为1．98％,明显低于BE（P〈0．01）。结论BE检出率较高,以短段、岛状和舌状多见,多无症状,以中年男性多见,肠化生仅占有1／3,与RE无明显相关性。     

放大内镜下氩离子凝固术对Barrett食管诊治研究

目的评价色素放大内镜结合氩离子凝固术(APC)对Barrett食管(BE)诊断及治疗效果。方法对26例经病理确诊BE病例观察其放大内镜特点并行氩离子凝固治疗,于术后3个月、半年及1年复查,观察近期疗效。结果所有患者均完成APC治疗,无并发症出现,共随访1年其中5例再次发现柱状上皮。结论放大内镜结合APC治疗Barrett食管安全、有效易行,但有一定比例复发,须定期复查。     

内镜窄带成像技术在Barrett食管诊断中的应用

<正>Barrett食管(Barrett’s esophagus,BE)是食管下段正常的复层鳞状上皮被化生的单层柱状上皮所替代的一种病理现象,可伴或不伴肠上皮化生。目前Barrett食管的诊断主要依靠内镜检查,病理活检是金标准。但是常规内镜检查对Barrett食管的检出率低。窄带成像技术(narrow band imaging,     

窄带成像放大内镜在Barrett食管诊断中的应用

目的：了解窄带成像放大内镜（ NBI-ME）在诊断Barrett食管中的临床价值。方法选择2012年1月-2013年10月内镜下肉眼观胃食管结合处（ GEJ）近端出现桔红色柱状上皮的患者86例,按掷硬币法随机分为观察组47例和对照组39例。观察组在窄带成像放大内镜下取活检;对照组在常规胃镜下取活检。结果观察组中肠上皮化生者26例（55.3%）,其中不典型增生4例;对照组中肠上皮化生者9例（23.1%）,其中不典型增生1例。2组比较差异有统计学意义（ P﹤0.05）。结论窄带成像放大内镜能有效提高Barrett食管的检出率,有一定的临床推广价值。     

窄带成像内镜下氩离子凝固术治疗Barrett食管疗效分析

目的评价窄带成像（NBI）内镜下氩离子凝固术（APC）治疗Barrett食管的疗效。方法将180例经NBI内镜检查及病理确诊的Barrett食管患者随机分成A、B两组,其中A组90例在NBI内镜下行APC治疗,术后常规予质子泵抑制剂（PPI）治疗8周,部分患者8周后继续给予PPI按需症状控制治疗,B组90例单纯服与A组相同的药物,所有病例均于治疗后每3个月、6个月、9个月、1年进行复查,两组进行对比,评价NBI内镜下APC治疗Barrett食管的疗效。结果 A、B两组临床症状均明显改善,差异无统计学意义（P〉0.05）,A组食管黏膜内镜表现和组织学与A组相比改善明显,差异有统计学意义（P〈0.05）,随访1年后A组BE复发率较低,为5.6%,未发现有重度非典型增生和癌变病例。B组发现重度非典型增生和黏膜内癌各1例,均予行内镜下黏膜切除术（EMR）治疗。结论 NBI内镜下APC治疗可明显改善BE患者的临床症状和BE黏膜,治疗后残留及复发率低,是一种安全、有效治疗BE的内镜治疗方法,值得临床推广应用。     

Barrett食管的内镜与病理特征分析

近年来,食管及食管-胃连接部腺癌的发病率明显升高。Barrett食管(BE)为食管腺癌的重要癌前病变,已日益受到重视。现收集我院胃镜室经内镜及病理组织学诊断的BE89例资料,通过对其临床、内镜及病理特征进行回顾性分析,以提高对本病的认识及诊疗水平。1临床资料1.1一般资料2003年1     

Barrett食管30例临床症状、内镜表现及病理分析

目的 探讨Barrett食管(BE)的临床症状、内镜表现及病理分析.方法 收集我院确诊为BE患者的胃镜及病理资料进行回顾性分析.结果 30例BE患者有反酸、胸骨后烧灼感、吞咽不适、胸骨后疼痛等症状.内镜下伴有反流性食管炎、胃溃疡、食管裂孔疝、胆汁反流等,内镜下表现呈环形BE 11例(37%),岛状BE12例(40%),舌形7例(23%).病理检查胃底上皮13例(43%),交界型上皮6例(20%),肠化型上皮11例(37%),其中1例交界型上皮伴轻度异型增生,未发现食管腺癌.结论 BE多发于反流性食管炎者,是食管腺癌的一种癌前病变,BE的早期诊断和治疗对降低食管腺癌的发病率起到了非常关键的作用.     

内镜对21例Barrett食管的诊断分析

Barrett食管（BE）是指远端食管正常复层鳞状上皮被胃黏膜柱状上皮取代的病理现象，为长期慢性胃食管反流病（GERD）的严重并发症，由于本病与食道下段腺癌的发病率有直接的关系而逐渐受到重视。本文回顾分析我院2003年8月至2006年12月，因上消化道症状来我院行内镜检查发现的21例Barrett食管的资料，现就其内镜特征、临床表现及病理结果报告如下：     

射频联合抑酸逆转Barrett食管上皮的临床研究

Barrett食管(BE)是指食管下段的正常鳞状上皮被覆柱状上皮取代的一种病理状态[1]。常被认为是一种癌前期的组织学改变,其发生食管癌的危险性较一般人群高30~50倍。现行的治疗方法主要是抑酸药物治疗和外科食管切除术,但前者仅可缓解症状,而无法逆转其肠上皮化生转为Barrett食管的病程,不会减少发生癌变的危险性。后者有一定的手术致死率、手术并发症及手术禁忌证[2].我科自2003年以来在抑酸条件下,采用内镜下经射频治疗Barrett食管26例,并与20例传统质子泵抑制剂治疗对照组进行了对照,现将结果报告如下。1资料与方法1.1一般资料患者46例,…     

Barrett食管的临床研究

目的:分析Barrett食管(BE)的病因、内镜下特征表现及临床病理特点,探讨BE和食管腺癌的关系.方法:分析86例BE患者的临床表现、内镜诊断及病理特点.结果:所有患者均有反流性食管炎的症状.根据症状分为四组:烧心、反酸、吞咽不利、胸骨后或剑突下痛.在内镜下可分为全周型(40例)、岛型(28例)和舌型(18例).活组织检查结果示:胃底腺型上皮35例、胃贲门交界型上皮39例、特殊型柱状上皮12例.其中不典型增生者15例,尚未发现癌变.结论:BE是反流性食管炎发展的一种结果,其诊断需内镜和活组织检查,对BE的随诊观察可早期发现食管癌.     

COX-2在Barrett食管和食管腺癌中的表达

目的：探讨COX-2与Barrett食管及食管腺癌的关系。方法：用RT-PCR、免疫组织化学等方法分别测定Barrett食管组（16例）、食管腺癌组（17例）和正常对照组（20例）食管黏膜中COX-2及其mRNA的表达。结果：RT-PCR示14例Barrett食管、15例食管腺癌和5例正常黏膜中COX-2mRNA呈阳性表达：免疫组化示13例Barrett食管上皮细胞、13例食管腺癌细胞和4例正常黏膜细胞胞浆中COX-2蛋白呈阳性表达．前两组COX-2mRNA和COX-2蛋白表达率差异无统计学意义（P〉0．05），但均高于对照组（P〈0．01）。结论：COX-2及其mRNA在Barrett食管和食管腺癌中呈高表达。COX-2可能与Barrett食管及食管腺癌的形成有关。关键词Barrett食管食管肿瘤腺癌前列腺素内过氧化物合酶。     

氩离子凝固术联合药物治疗Barrett食管疗效分析

目的APC联合埃索美拉唑治疗BE的临床疗效及安全性。方法将92例BE随机分为A、B治疗组和对照组,A组服用埃索美拉唑及莫沙必利;B组行APC加服与A组相同的药物;而对照组未予特殊治疗。比较3组患者治疗后的临床症状、内镜表现及组织学改变情况。结果A、B治疗组临床症状均明显改善,与对照组相比差异有统计学意义（P〈0．05）;A组与对照组内镜表现和组织学改变无明显改善（P〉0．05）;B组31例（100％）患者BE食管黏膜内镜表现和组织学恢复正常,与另外两组相比改善有统计学差异（P〈0．05）。结论APC联合埃索美拉唑、莫沙必利方案可明显改善BE患者的临床症状和内镜表现,是一种安全、有效治疗BE的综合治疗方法。     

Clinical experience of patients undergoing photodynamic therapy for Barrett's dysplasia or cancer

INTRODUCTION: Barrett's oesophagus is the most important risk factor in the increase in incidence of oesophageal adenocarcinoma. Photodynamic therapy using porfimer sodium is the only approved endoscopic treatment for use in patients with Barrett's high-grade dysplasia. AIM: To determine clinical characteristics, endoscopic findings and treatment complications in Barrett's high-grade dysplasia patients undergoing photodynamic therapy. METHODS: We reviewed our experience using porfimer sodium photodynamic therapy to treat patients with Barrett's oesophagus and high-grade dysplasia or mucosal carcinoma. Data collected included patients characteristics, presentation symptoms, endoscopic findings, subsequent use of surveillance endoscopy and outcome after photodynamic therapy. RESULTS: Since 1997, 102 patients with Barrett's high-grade dysplasia (69 patients) or mucosal adenocarcinoma (33 patients) have been treated with photodynamic therapy using porfimer sodium as an alternative to oesophagectomy (median series follow-up time = 1.6 years). Almost half (46%) of patients had high-grade dysplasia or carcinoma detected on their first endoscopy and the remainder (54%) were found during surveillance of known Barrett's oesophagus. Symptoms typically associated with oesophageal disease were only found in 29 of 47 (62%) patients in whom dysplasia/carcinoma was detected on the initial endoscopy - chest pain in 13 patients, dysphagia in nine patients and chronic gastro-oesophageal disease in seven patients. Comparison of endoscopic characteristics found the median Barrett's glandular segment length was significantly shorter in adenocarcinoma patients (median 3 cm; range: 1-12) vs. Barrett's high-grade dysplasia patients (median 5 cm; range: 1-16, P < 0.001). Overall treatment results found complete ablation of glandular epithelium with one course of photodynamic therapy in most patients (56%). Stricture requiring dilation occurred in 20 patients (20%) was the most common serious adverse event. Photodynamic therapy failed to ablate dysplasia or carcinoma in four patients and subsequent oesophagectomy was curative in three of these patients. CONCLUSIONS: Approximately 40% of newly diagnosed patients with Barrett's associated dysplasia or carcinoma had no oesophageal symptoms and had carcinoma associated with short segment (3 cm or less). Photodynamic therapy is a highly effective, safe and minimally invasive first-line treatment for patients with Barrett's dysplasia and mucosal adenocarcinoma.     

放大胃镜和FICE技术对胃黏膜癌前病变及早癌的诊断价值

目的探讨FICE结合放大内镜在上消化道早癌病变中的诊断价值。方法回顾分析FujinonEG590ZW型胃镜检查经病理诊断为肠上皮化生、异型增生和早癌的70例患者。结果放大内镜加FICE技术对胃黏膜肠上皮化生、异型增生和早癌的诊断与病理诊断符合率分别为96．8％、92．6％和91．7％。结论FICE结合放大内镜对胃黏膜癌前病变及早癌具有较高诊断价值。     

The association of body mass index with Barrett's oesophagus

BACKGROUND: Obesity has been linked to gastro-oesophageal reflux disease symptoms and oesophageal adenocarcinoma; however, there is no published evidence for an association with Barrett's oesophagus. AIM: To investigate the association between obesity and Barrett's oesophagus. METHODS: We conducted a retrospective cross-sectional study of patients who underwent upper endoscopy at the Southern Arizona Veteran's Affairs Healthcare System between 1998 and 2004. We examined male patients without malignancy, with available information on weight and height. Based on endoscopic and histological findings, patients were classified as cases with Barrett's oesophagus or non-cases without Barrett's oesophagus. Multivariable logistic regression analysis was conducted to examine the association of body mass index and obesity with Barrett's oesophagus and Barrett's oesophagus length while adjusting for age and race. RESULTS: There were 65 cases with Barrett's oesophagus and 385 non-cases without Barrett's oesophagus. The mean body mass index was significantly higher in cases than in non-cases (29.8 vs. 28.0, P = 0.03). Cases had significantly greater mean weight than controls (206 lb vs. 190,P = 0.005). The proportions of cases with body mass index 25-30 and body mass index > or =30 were greater than those in non-cases (44.6% vs. 37.7%) and (40.0% vs. 33.5%), respectively (P = 0.08). In the multivariable logistic regression model adjusting for race and age, when compared with body mass index < 25, the odds ratio was 2.43 (95% confidence interval: 1.12-5.31) for body mass index 25-30 and 2.46 (1.11-5.44) for body mass index > or =30. When examined as a continuous variable the adjusted odd ratio for each five-point increase in body mass index was 1.35 (95% confidence interval: 1.06-1.71, P = 0.01). The association between weight and Barrett's oesophagus was also statistically significant (adjusted odd ratio for each 10 pound increase = 1.10, 1.03-1.17, P =0.002). Among the 65 cases of Barrett's oesophagus, there was no correlation between the length of Barrett's oesophagus at the time of diagnosis and the body mass index (correlation coefficient = 0.03, P = 0.79). CONCLUSION: This retrospective cross-sectional study in male veterans shows that overweight is associated with a two-and-half-fold increased risk of Barrett's oesophagus. Larger studies of the underlying mechanism are warranted to better understand how and why obese patients are at greater risk for Barrett's oesophagus.     

内镜下高频电凝固术治疗Barrett食管56例临床分析

目的探讨内镜下高频电凝固术（HFE）在Barrett食管（BE）治疗中的临床应用价值。方法将112例BE患者随机分为观察组和对照组各56例,对照组采用PPI治疗,观察组同时采用HFE治疗。结果观察组术后第3、12个月胃镜复查其总有效率均为100.00%,对照组分别为12.50%和30.36%,两组比较,差异均有统计学意义（P〈0.01）。结论采用HFE治疗BE方法简单、安全、疗效显著,值得临床推广。     

54例SARS患者胸部影像学表现分析

目的：探讨SARS的影像学表现、分型与诊断。方法：54例临床诊断的SARS患者均有系列胸片，23例有CT资料，进行回顾分析。胸片分型为：单纯型(Ⅰ)、进展型(Ⅱ)、迁延型(Ⅲ)。对18例临床治愈出院后胸片、CT复查结果进行对比分析。结果：54例中，15例以肺实质渗出、实变为主，5例以肺问质浸润为主，34例兼有肺实质、间质病变。Ⅰ型(n=12)胸片表现多不具特征性，预后好；Ⅱ型(n=25)胸片表现具有相对特征性，病死率高(16％)；Ⅲ型(n=17)残留病变最多(100％)。CT显示残留病变比胸片更清楚。结论：SARS影像学表现仅具有相对特征性，诊断必须结合临床、流行病学和实验室检查。     

高频电联合抑酸剂、抗反流药物及黏膜保护剂治疗Barrett食管

目的观察内镜下高频电联合抑酸剂、抗反流药物及黏膜保护剂治疗Barrett食管的疗效。方法对62例经内镜和病理确认的Barrett食管患者,采用高频电在病灶处灼凝,并应用泮托拉唑、莫沙必利及复方铝酸铋颗粒治疗20d。结果治疗结果59例治愈,临床症状消失,内镜并结合病理复查为新生的鳞状上皮,有效率为95.16%。除少数患者出现短暂胸骨后疼痛、咽下疼痛及低热外,无感染、出血、穿孔等并发症。结论高频电联合抑酸剂、抗反流药物及黏膜保护剂综合治疗Barrett食管,对Barrett上皮的修复效果好,创伤小,并发症少,有重要临床推广意义。