原发性食管腺、鳞癌诊断比较分析

目的分析原发性食管腺癌的临床、诊断特点.方法回顾、对比分析本院10年间收治的39例原发性食管腺癌、39例食管鳞癌病例(同期430例食管鳞癌随机筛选出)的临床资料,以及患病10年前反流性食管炎的病史情况.结果食管腺癌患病率占同期收治食管癌的8.3%(39/469).其症状有吞咽困难,胸骨后疼痛,反酸及胸骨后烧灼感,黑便或呕血,消瘦或乏力不适.与食管鳞癌患者相比,除反酸及胸骨后烧灼感症状出现频率(51.3%)高于食管鳞癌(23.1%)外,其他症状出现频率两者相近.食管腺癌好发于食管下段(76.9%),而食管鳞癌好发于食管中上段(74.6%);食管腺、鳞癌的早期诊断率分别为5.1%、23.1%;64.1%原发性食管腺癌患者既往有类似反流性食管炎症状的病史,食管鳞癌患者仅有17.9%有反流症状.结论提高原发性食管腺癌的早期诊断率在于对有反酸及胸骨后烧灼感等反流性食管炎类似症状者常规行胃镜检查以提高Barrett食管的检出率,对Barrett食管患者的定期内镜复查十分必要.

Comparative Analysis of the Diagnosis About Primary Esophageal Adenocarcinoma and Esophageal Squamocellular Carcinoma

Objective To research the clinical and diagnostic characters of primary esophageal adenocarcinoma. Methods Clinic data, and the history of reflux esophagitis ( RE) 10 yeare ago of 39 cases of primary eaophageal adenocarcinoma ( EAC) treated in our hospital in the past 10 years and 39 cases of esophageal squamocellular carcinoma ( ESC, by random sampling from all 430 cases of the esophageal cancer in the corresponding period) were analysed retrospectivel. Results The cases of EAC is 8. 3% of all of esophageal carcinoma in the corresponding period (39/469). It's symptoms include gulp obstruction,sternum rear burning,black excrement,haematemesis,marasmus and feebleness. Compared to ESC .except that the frequency of sternum rear pain and backstreaming of acid reflux (51. 3% ) were higher than ESC (23. 1% ) ,the frequencies of EAC' s other symptoms were similar to those of ESC. EAC were mainly found in the underneath of esophagus (76.9% ) , however ESC were mainly found in middle and upper segment (74.6% ). The early diagnostic rate of EAC and ESC were 5. 1% ,23.1 % respectively. 64.1 % cases of primary EAC have previously symptoms similar to RE,contrasted to 17. 9% of ESC. Conclusion To diagnose primary EAC early,gastroscopy should regularly be made for the patients with symptoms similar to RE, and for the patients with Barrett' s esophagus, gastroscopy should be reexam-ined periodically.