内镜窄带成像技术对Barrett食管合并 早期食管腺癌的诊断价值

目的 探讨内镜窄带成像技术（NBI）对Barrett食管（BE）患者早期食管腺癌的诊断价值。方法 选取176例内镜诊断为BE的患者，分别在常规白光摸式、NBl模式及1.2％碘溶液染色模式下观察，对所有可疑病变部位均取活检，所有病变均以病理结果作为诊断标准，分别与病理诊断结果对比。结果 176例患者，病理诊断BE的160例，其中3例被诊断为早期食管腺癌（EAC），将3种方法的结果相比，对敏感度、特异度、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比进行比较。NBI和复方碘溶液的敏感性和阴性预测值均为100%，两者的特异性分别为89.8%和91.7%，均优于常规白光内镜。 结论 NBI技术对BE合并早期食管腺癌具有高灵敏度和高阴性预测值，它的结果与复方碘溶液染色所获得的结果具有可比性。     

醋酸染色联合内镜智能分光比色技术对检测Barrett食管上皮和Barrett相关性肿瘤的价值

目的探讨醋酸染色联合内镜智能分光比色技术(FICE)技术在Barrett食管(BE)和Barrett相关性肿瘤的作用。方法选择60例经胃镜检查诊断为BE患者,分别采用普通模式、醋酸染色联合FICE模式对病变形态、腺管开口分型及毛细血管形态观察,对病变作出诊断,并与病理组织学诊断相比较。结果醋酸联合FICE对BE腺管开口形态及毛细血管结构清晰度均优于普通放大内镜(P=0.00<0.05);高级别上皮内瘤变和癌的病例中,不规则的黏膜形态在普通模式组和醋酸染色联合FICE组中的阳性率分别是16.7%、100%,不规则血管形态的阳性率分别是16.7%、83.3%;醋酸染色联合FICE对Barrett食管肿瘤性病变诊断符合率为93.3%、敏感性91.6%、特异性93.8%,与普通放大内镜相比在符合率、敏感性上差异有显著性(P<0.05)。结论醋酸染色联合FICE可清楚观察BE黏膜病变形态、腺管开口形态及毛细血管结构,对于提高诊断Barrett相关性肿瘤病变的准确性具有良好的临床实用价值。     

Barrett食管与食管腺癌——3例报告及文献复习

目的Barrett食管在我国少见,故复习文献并报告Barrett食管合并食管腺癌3例。方法复习北京协和医院近10年来手术切除的食管癌病例,其中Barrett食管合并食管腺癌仅有3例。结果3例均为男性,平均年龄56岁。2例为贲门型／交界型Barrett食管,1例为特异型Barrett食管;其中1例合并印戒细胞癌,2例合并低分化腺癌。结论诊断Barrett食管时应注意病变的解剖学部位,以避兔过度诊断。     

Barrett食管并发食管腺癌2例

目前普遍认为Barrett食管是食管腺癌的癌前病变,80%的食管腺癌来源于Barrett食管[1].现将本院在2003年7月发现2例Barrett食管并发食管腺癌报道如下.     

Barrett食管的诊断及其癌变与COX-2的相关性研究进展

Barrett食管(Barrett's esophagus)是1950年由英国心胸外科医生Norman Barrett首先提出而得名,是一种具有重要临床意义的食管疾病。它与食管腺癌的发生密切相关,是一种主要的食管腺癌癌前病变。有文献报道约5%的Bar-rett食管患者发生癌变,较正常人群高出40~100倍[1]。环氧合酶2(cycloxygenase,COX-2)为诱导性酶,参与细胞对生长因子、肿瘤促进因子和细胞因子的反应。本文对Barrett食管的诊断和癌变过程及其与COX-2的相关性进行综述。1 Barrett食管的诊断Barrett食管是指食管下段的复层鳞状上皮细胞被单层柱状上皮细胞取代的一种病理现…     

Barrett食管的诊疗进展

近年来食管腺癌的发病率不断增高,在某些西方国家甚至超过了食管鳞状细胞癌。Barrett食管是食管腺癌的高危因素,因此受到业界越来越多的关注。早期识别Barrett食管、早期诊断、早期治疗对于食管腺癌预后的改善意义重大。本文就Barrett食管的定义、诊断手段及治疗措施作一综述。     

窄带成像技术在Barrett食管中的应用

Barrett食管是公认的食管腺癌的癌前病变,因此早期诊断Barrett食管甚为重要.近年来出现的一项新技术——窄带成像.给早期发现Barrett食管中的可疑病变、提高活检检出率提供了新的检查手段.本文就窄带成像技术在Barrett食管中的应用作一综述.     

Barrett食管和食管腺癌相关microRNAs研究进展

食管腺癌是发达国家中发病率最高的肿瘤之一,其病因主要与胃、食管反流和Barrett食管密切相关。目前以手术为主的治疗方法效果并不理想。microRNAs(miRNAs)可使多种靶基因失活。在Barrett食管和食管腺癌中,miRNAs也存在异常表达,其异常表达对于Barrett食管和食管腺癌的诊断、治疗和预后判断有重要的指导意义。     

54例Barrett食管临床研究

目的 分析Barrett食管（barrecc esophagus，BE）患者的临床特点，尤其是胃镜下表现度食管动力改变，以提高BE的诊断率，以期早期治疗。方法 回顾分析54例BE患者的临床资料。结果 22例行食管动力检查提示LESP厦屏障压（LESP-GS）明显降低，酸反流总时间、酸反流总次数以度食管下段pH〈4时间百分比均明显增加。系统治疗后，41例患者在该院行胃镜复诊，21例（51．22％）仍为BE，19例（46．34％）患者恢复正常食管上皮，1例（2．44％）进展为食管腺癌。结论 BE是胃食管反流痛（gastroesophageal reflux disease，GERD）严重的并发症；内镜下治疗联合抑酸治疗为BE治疗提供新的方法。     

Barrett食管与胃食管反流病及食管腺癌的关系

胃食管反流(gastroesophageal reflux,GER)在人群中普遍存在,Barrett食管(Barrett’s esophagus,BE)及食管腺癌(esophageal adenocarcinoma,EA)的发病率也在逐年升高。为了解BE与胃食管反流病(gastroesophageal reflux dis-ease,GERD)、EA的关系,本文复习近年相关文献,从病理生理基础及诊断、治疗方法入手进行探讨,结果发现三者的病情进展过程为正常食管黏膜-GERD-BE化生-BE低度和高度异型增生-EA。故BE的治疗应以减轻GER症状为主,并定期筛检和评价预后,以早期发现EA。     

Barrett食道和Barrett食道腺癌的临床病理学研究

本文报告Ｂａｒｒｅｔｔ食道４２例，其中８例具有腺癌结构。内镜观察：食道粘膜上皮粗糙、糜烂、颗粒状增生、斑块状隆起、溃疡、粘膜充血或苍白。组织学观察：Ｂａｒｒｅｔｔ食道上皮有三种不同形态，其中胃底型上皮８例，交界型上皮１４例，特殊型上皮２０例，８例具有腺癌结构，特殊型上皮与腺癌结构间可见过渡形态。粘液组化染色观察：２０例特殊型上皮，ＨＩＤ（＋）１８例，８例具有腺癌结构的病例，ＡＢ、ＨＩＤ均呈不同程度的阳性。ＡｇＮＯＲ染色观察，Ｂａｒｒｅｔｔ食道三种上皮与食道腺癌平均每核含ＡｇＮＯＲ颗粒数相比均有非常显著的统计学差异（Ｐ＜０．０１）；观察结果提示：Ｂａｒｒｅｔｔ食道与食道腺癌关系密切，特殊上皮型Ｂａｒｒｅｔｔ食道可能是食道腺癌的癌前病变。     

120例氩离子凝固术治疗Barrett食管患者的护理体会

目的探讨内镜下氩离子凝固术(APC)治疗Barrett食管(BE)的围术期护理方法。方法选择120例BE患者进行APC治疗,术前积极做好准备工作,木中熟练配合医生、密切观察患者反应,术后严密监测生命体征、加强健康教育。结果本组患者APC治疗均顺利完成,术后仅10例出现轻度咽喉部疼痛,无穿孔、出血等并发症发生。结论 APC是有效治疗BE的新方法,精细化的围术期护理是治疗成功和有效预防及减少并发症的重要保证。     

内镜窄带成像诊断Barrett食管的作用研究

目的 探讨内镜窄带成像在早期发现Barrett仕食管(BE)中的特殊肠上皮化生(SIM)细胞等癌前病变中的作用.方法 2008年6月～12月间,共25例经胃镜检查确诊为内镜BE患者,分别采用普通模式、NBI模式进行观察,并用NBI模式进行BE黏膜腺管开口分型,于改变最明显处取活检行病理检查.结果 在对鳞一柱状上皮交界的病变轮廓、黏膜腺管开口形态及毛细血管结构形态的观察中,NBI显著优于普通内镜;NBI模式下通过Endo分型,其Ⅳ型、V型腺管开口检出SIM的准确性、敏感性、特异性分别为92%、86%及94%.结论 NBI可清晰观察BE黏膜病变轮廓、腺管开口形态及毛细血管结构形态;操作转换简单易行,对BE食管进行靶向活检具有良好指导意义及临床使用价值.     

Barrett's esophagus complicating scleroderma

Two patients with scleroderma whose esophageal involvement was associated with longstanding reflux esophagitis were found to also have Barrett's esophagus. Since Barrett's esophagus is a premalignant condition, these patients with scleroderma should be considered at high risk for the development of adenocarcinoma of the esophagus.     

Radiologic diagnosis of Barrett's esophagus: Critical analysis of 65 cases

A recent increase in the number of Barrett's esophagis being diagnosed is probably directly related to a proportional increase in endoscopic biopsies of the esophagus and awareness of premalignant potential of Barrett's mucosa. While the endoscopist can detect Barrett's mucosa with fair degree of accuracy, the radiologic diagnosis of Barrett's esophagus still remains a diagnostic challenge despite several well established radiologic features. We reviewed 65 patients with pathologically proven Barrett's esophagus and found a wide spectrum of radiologic features. These include hiatus hernia in 49, gastroesophageal reflux in 38, strictures in 32, esophagitis in 20, and characteristic Barrett's ulcer in 12. In addition ascending or migrating strictures were found in 10, mucosal pattern simulating areae gastricae in 5, cricopharyngeal dysfunction in 4, and fixed spiral folds in 3 patients. This constellation of radiologic features, some of which have not been previously emphasized, should further assist radiologists in suggesting the diagnosis of Barrett's esophagus.     

氩离子凝固术联合药物治疗Barrett食管的前瞻性研究

目的:研究氩离子凝固术联合药物治疗对Barrett食管的疗效及安全性。方法:经胃镜及病理组织活检确诊的Barrett食管患者113例,随机分为3组,Ⅰ组23例为对照组,未给予治疗;Ⅱ组33例给予口服奥美拉唑;Ⅲ组48例行氩离子凝固术后并口服药物(同Ⅱ组)维持,3个月后复查,若发现有残留Barrett食管,再次行氩离子凝固术治疗1次。所有患者治疗1年,并在治疗6个月及12个月时复查内镜并行病理组织活检,比较3组治疗前、后临床症状、胃镜检查及病理组织活检结果。结果:Ⅰ组临床症状无明显改变,Ⅱ组与Ⅲ组均较治疗前明显改善。Ⅰ组与Ⅱ组Barrett食管未见明显变化。Ⅲ组能使89.6%的Barrett食管达到胃镜下完全消除,1年后复发率为25.6%,至随访结束时,完全缓解Barrett食管占治疗的66.7%。结论:氩离子凝固术联合药物治疗既可改善Barrett食管的症状,也可消除Barrett食管,但复发率较高。     

Barrett's esophagus in scleroderma: Increased prevalence and radiographic findings

Ten of 27 patients (37%) with scleroderma who underwent endoscopy at our hospital between 1980 and 1984 for symptoms of reflux esophagitis had biopsy-proven Barrett's esophagus. Two of those 10 patients had esophageal adenocarcinomas. In a blinded review of esophagrams (all but 2 using double-contrast technique) from 16 of the 27 patients, only 1 patient was thought to be at high risk for Barrett's esophagus due to a high esophageal stricture with an adjacent reticular pattern of the mucosa. The latter patient had biopsy-proven Barrett's mucosa. Eight patients were thought to be at moderate risk for Barrett's esophagus due to reflux esophagitis and/or distal strictures in 6 and polypoid intraluminal masses in 2. Three of the 6 patients with esophagitis and/or strictures had Barrett's esophagus, and both patients with masses had adenocarcinomas arising in Barrett's mucosa. Finally, 7 patients who had no esophagitis or strictures were thought to be at low risk for Barrett's esophagus. None of those 7 had histologic evidence of Barrett's mucosa. Thus, the major value of double-contrast esophagography is its ability to classify patients into high-, moderate-, and low-risk for Barrett's esophagus to determine the relative need for endoscopy and biopsy in these patients.     

Current practice compared with the international guidelines: endoscopic surveillance of Barrett's esophagus

RATIONALE, AIMS AND OBJECTIVES: To describe the current practice for the surveillance of patients with Barrett's esophagus, to compare this practice with the national guidelines published by the French Society of Digestive Endoscopy in 1998 and to identify the factors associated with the compliance to guidelines. METHOD: To determine the attitudes of French hepatogastroenterologists to screening for Barrett's oesophagus, a postal anonymous questionnaire survey was undertaken. It was sent to 246 hepatogastroenterologists in the Rhone-Alpes area. We defined eight criteria allowed to assess the conformity of practices with the guidelines. We created three topics composed of several criterion. The topics analysed were 'Biopsies', 'Surveillance' and the diagnosis of high grade dysplasia. We studied the factors which could be associated with the compliance with the guidelines. RESULTS: The response rate was 81.3%. For 58.0% of the gastroenterologists, endoscopic biopsy sampling were made according to French guidelines (four-quadrant biopsies at 2 cm intervals). Agreement was 78.0% regarding the interval of surveillance for no dysplasia (every 2 or 3 years) and 78.5% regarding the low-grade dysplasia (every 6 or 12 months). For the management of high-grade dysplasia, 28.6% actually confirm the diagnosis by a second anatomopathologist and 42.0% treated by proton pump inhibitor during 2 months. Concerning the biopsies, the young gastroenterologists and gastroenterologists practising in university hospitals had a better adherence to the guidelines (Relative Risk: 2.22, 95% CI 1.25-3.95 and 3.74, 95% CI 1.04-13.47, respectively). The other factors of risk were not statistically significant. CONCLUSIONS: The endoscopic follow-up is mostly realized in accordance with the national guidelines. However, there is a wide variability in individual current practice.     

复合结扎加抑酸治疗Barrett食管

目的观察抑酸加复合结扎治疗Barrett食管(BE)的临床效果。方法对40例经内镜和病理诊断为BE的病人,分别采取抑酸加复合结扎(治疗组)和抑酸加抗反流(对照组)治疗。于治疗后3、6、12个月分别进行内镜和病理检查,观察两组BE病人治疗情况。结果治疗组20例BE病人,治疗后3、6、12个月时的有效率分别为65%、70%、80%,而对照组则分别为0、0、25%。治疗组除出现短暂的吞咽疼痛、低热外,无出血、穿孔、狭窄等并发症。结论抑酸加复合结扎治疗BE,疗效高,见效快,长疗程抑酸加抗反流对BE治疗有一定作用。