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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。结暴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。
Objective To analyze the clinical and diagnostic features of primary esophageal adenocarcinoma. Methods The clinical data of 39 cases of primary esophageal adenocarcinoma and 39 cases of esophageal squamous cell carcinoma (430 cases esophageal squamous cell carcinoma randomly selected in the same period) were retrospectively analyzed and compared in our hospital over the past 10 years. Esophagitis history. The prevalence of stool esophageal cancer in the same period accounted for 8.3% of esophageal cancer (39/469). Symptoms include difficulty swallowing, sternal pain, soreness after acid reflux and sternum, melena or hematemesis, weight loss or fatigue. Compared with patients with esophageal squamous cell carcinoma, the frequency of symptomatic occurrence of other symptoms was similar except that the frequency of symptomatic acidosis and retrosternal burning sensation was higher (51.3%) than esophageal squamous cell carcinoma (23.1%). Esophageal adenocarcinoma occurred in the lower esophagus (76.9%), while esophageal squamous cell carcinoma was found in the upper esophagus (74.6%). The early diagnosis rates of esophageal gland and squamous cell carcinoma were 5.1% and 23.1%, respectively. 64.1% Patients with esophageal adenocarcinoma had a history of reflux-like esophagitis, with only 17.9% of patients with esophageal squamous cell carcinoma having reflux symptoms. Conclusions The early diagnosis rate of primary esophageal adenocarcinoma lies in the routine gastroscopy for reflux reflux esophagitis patients with reflux symptoms such as acid reflux and sternal burning to improve the detection rate of Barrett’s esophagus. Endoscopy review is necessary.