Barrett食管的临床病理特征分析

目的探讨内镜下拟诊为Barrett食管(BE)患者的临床症状、内镜下表现类型和病理特征之间的关系。方法对184例内镜下拟诊为BE的患者进行临床症状评估,HE染色行病理组织学分析。并对临床症状、内镜下表现类型及病理特征之间的关系进行相关分析。结果内镜下拟诊184例BE患者,反酸33例次,反食7例次,烧心23例次,胸骨后疼痛13例次,上腹痛70例次,上腹胀38例次,其中10例患者有食管外症状(咳嗽、咽炎等);37例无明显症状。内镜表现类型岛型128例,环周型43例,舌型13例。活检证实有柱状上皮化生88例(占47.8%),其中有46例可见肠上皮化生,发现1例不典型增生。病理确诊的46例肠化BE和42例非肠化BE患者的反酸发生率明显高于非BE患者,其他临床症状比较无明显差异;内镜下拟诊的3种类型的BE患者临床主要症状比较无明显差异;内镜表现为环周型、岛型和舌型BE的柱状上皮化生和肠化生的检出率无明显差异。结论(1)病理确诊的BE患者反酸的发生率明显高于非BE患者。(2)BE患者内镜表现类型与症状无关。(3)内镜表现以岛状多见,柱状上皮化生和肠上皮化生在3型BE中检出率无差异。

The Clinical and Pathological Analysis of Barrett Esophagus

Objective To investigate the correlation among the clinical character,endoscopic classification and pathological character of Barrett esophagus(BE) diagnosed by endoscopy.Methods Clinical character,endoscopic classification and pathological character were assessed in 184 BE patients diagnosed by endoscopy.Results 147 patients had typical,atypical symptoms of gastroesophageal reflux disease and eipgastric symptoms:heartburn 23 cases,acid reflux 33 cases,regurgitation 7 cases,chest pain 13 cases,eqigastric pain 70 cases,eipgastric fullness 38 cases;10 of 147 patients had extraesophageal symptoms.37 patients had no symptoms.Endoscopic classification inluded lamellar 128 cases,circumferential 43 cases and tongues 13 cases.Columnar epithelium metaplasia was confirmed in 88 cases(47.8%)by the histopathology,intestinal metaplasia was confirmed in 46 of 88 cases and dysphasia in one case.There are no significantly differences in clinical manifestation between patients with or without ccolumnar epithelium metaplasia as welll as among patients with three different endoscopic classifications except the prevalence of acid reflux in patients with ccolumnar epithelium metaplasia was significantly higher than those without columnar epithelium metaplasia.Conclusion BE patients diagnosed by pathology had high prevalence of acid reflux.There is no siginificantly difference between clinical manifestation and endoscopic classifications.Columnar epithelium metaplasia can occur in three types of endoscopic classifications.