贲门脊根部黏膜形态异常前瞻性探究.docVIP

贲门脊根部黏膜形态异常前瞻性探究 　【摘要】 ［目的］ 前瞻性观察贲门脊根部黏膜形态异常病例的癌变情况，为提高对贲门高发部位的认识提供依据。［方法］ 851例内镜检查中发现的贲门脊根部黏膜充血、粗糙和糜烂等形态异常，但活检病理报告阴性的32例患者作为研究组，选择同时、同村、相同年龄和性别的79例黏膜正常，活检报告也为阴性者作为对照组。两组全部对象进行前瞻性随访15年。［结果］研究组32例中18例演变为贲门癌，癌变率为56.25%。对照组79例中4例发生贲门癌，癌变率为5.06%（P＜0.01）。［结论］ 贲门脊根部黏膜异常改变应视为癌前状态，宜定期随诊。 【关键词】 贲门肿瘤 A Prospective Study of Canceration Rate of Mucosal Abnormality at the Cardiac Mucosal Ridge Root Abstract: ［Purpose］ To investigate the canceration rate of mucosal abnormality at the root of cardiac mucosal ridge. ［Methods］ Of 851 cases undergoing endoscope examination, 32 cases with mucosal abnormality including congestion, roughness or erosion on the cardiac mucosal ridge root and biopsy proved no cancer were selected as the study group. Seventy-nine normal mucosal cases matching with sex, age and area were selected as control group. All cases in the 2 groups were prospective followed-up for 15 years after the initial endoscope examination. ［Results］ After 15 years follow-up, 18 cases were diagnosed as gastric cardiac cancer in study group, the canceration rate was 56.25% (18/32). Only 4 cases were diagnosed as gastric cardiac cancer in the control group, the canceration rate was 5.06% (4/79)(Plt;0.05). ［Conclusion］ The mucosal abnormality at root of cardiac mucosal ridge should be considered as precancerous status and followed -up periodically. Key words: cardiac neoplams; precancerous lesion; cardiac mucosal ridge 贲门腺癌高发位点位于贲门黏膜脊（即黏膜皱襞）根部，鳞状上皮和柱状上皮交界线下2cm，偏胃体侧。贲门腺癌高发位点的发现，对于贲门癌的早期诊断是一重大贡献[1]，早期贲门癌的诊断率不断上升。但是，关于贲门高发位点黏膜形态异常的长期队列随访结果，尚未见报道。本文报告在高发现场开展贲门黏膜异常１５年随访结果，以期进一步提高对贲门高发位点的认识，为高发区贲门癌的早诊早治提供参考依据。 1 材料与方法 本研究资料选自１９８５年林县食管癌营养干预研究，覆盖人群８５１人。该人群于１９８７年１２月进行了内镜复查。复查时，除外食管各种病变和已经确诊的贲门癌４３例（中晚期贲门癌１２例，早期贲门癌３１例），从851例内镜复查对象中，发现贲门脊根部黏膜充血、粗糙和糜烂等黏膜形态异常者３２例，在黏膜异常处咬取活检２块，病理报告未发现癌，该３２例作为研究组。选择同一天、同村和性别年龄相仿７９例，内镜观察贲门脊根部黏膜正常，咬取活检１块，病理报告未发现癌者作为对照组。 研究组３２例贲门黏膜异常者中，男性２２例，女性１０例，年龄４７~７０岁，中位年龄６０岁。对照组７９例研究对象中，男性５１例，女性２８例。年龄最小４５岁，最大７１岁，中位年龄６０岁。 从１９８７年１２月第一次内镜检查始，至２００２年１２月最后内镜随诊止，两组进行了１５年前瞻性随