内镜下卢戈氏液染色对早期食管癌和癌前病变的诊治价值

为了评价卢戈氏液内镜下食管黏膜染色对早期食管癌和癌前病变的诊断价值,对132例食管黏膜可疑病变经内镜以2%卢戈氏液喷洒染色,观察黏膜染色情况,并取活检送病理组织学检查。结果132例食管病变染色后,116例呈浅染色或不染色,其中食管癌9例(早期食管癌6例,进展期癌3例),Barrett食管6例,轻至中度不典型增生17例,早期食管癌内镜下切除3例。并发现有食管症状者碘不染区出现率(67.2%)明显高于无食管症状者(32.7%)。初步研究结果提示,内镜下应用卢戈氏液染色结合活检有助于早期食管癌和癌前病变的诊断,以及指导内镜下早期食管癌切除范围,且操作简便,具有重要的临床价值。     

18F-FDG PET显像在食管癌诊断中的临床意义

目的探讨正电子发射型电子计算机断层(positron emission computed tomography,PET)显像在食管癌早期诊断以及临床分期中的临床应用价值.方法23例食管癌患者,进行全身18F-脱氧葡萄糖(18F-fluoro-deoxy-glucose,18F-FDG ) PET显像,并与外科手术或内镜活检病理结果和CT检查结果对照.结果46例患者中PET显像食管部位均有异常放射性浓聚灶,经病理确诊,46处食管浓聚灶均为食管癌原发病灶.其中28例为单发病灶,2例为食管多发灶,其余16例除食管原发病灶外,还有其他部位32个病灶,经临床和病理证实为远处转移病灶.与46例PET显像前CT结果相比较,PET共检出食管部位恶性病灶46例,检出率为100.0%,而CT仅检出34例,检出率为73.9%.46例中确诊有其他部位转移者18例,PET检出18例,检出率为100.0%,而PET显像前CT仅检出6例,检出率为33.3%.27例手术治疗者PET分期与临床病理分期一致,而常规检查对食管癌临床分期高估5例,低估12例,PET显像改变了这17例患者的临床治疗方案.结论18F-FDG PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值.     

内镜切除治疗在早期食管癌和贲门癌及其癌前病变中的应用价值

目的 评价内镜套帽法切除早期食管癌、贲门癌及癌前病变的长期疗效和应用价值.方法 采用内镜套帽法切除早期食管癌、贲门癌及癌前病变147例(154个病灶),其中早期食管癌64例(69个病灶),癌前病变45例(47个病灶),病灶直径3～40 nm,平均(14.8±6.1)mm;早期贲门癌23例,癌前病变15例(均为单灶),病灶直径5～25 mm,平均(8.2±4.3)mm.全组病例均经病理证实.结果 全组有139个病灶被完全切除,完全切除率为90.3%.食管和贲门病灶的完全切除率均与病灶大小有关,病灶越大,完全切除率越低(P=0.001和P=0.014).147例患者中,内镜随访不足3年者66例,3～5年者31例,5～10年者43例,10年以上者7例.全组死亡11例,其中肿瘤复发死亡1例.早期食管癌和贲门痈的5年生存率分别为96.2%和100.0%.本组有5例(3.4%)患者发生术中出血,1例(0.7%)患者发生狭窄,无穿孔发生.结论 内镜黏膜切除治疗早期食管癌和贲门癌,符合其生物学特点,可达到传统手术治疗相同的长期疗效,亦适用于重度不典型增生的治疗.     

北方食管癌高发区食管和食管-胃交界部低级别内瘤变队列随访

目的:食管和贲门上皮不典型增生是癌前病变,分为轻度,中度和重度三个级别.2000年WHO建议用上皮内瘤变取代不典型增生,将轻度和中度归为低级别内瘤变,并将贲门腺癌称为食管-胃交界腺癌.本文探讨食管癌高发区食管和食管-胃交界部低级别上皮内瘤变癌变危险性和时间演变规律,为食管癌二级预防提供科学数据.方法:选择磁县2个乡于2001年10月～2002年10月,开展内镜碘染色队列筛查,干预乡0～85岁总人口数为22 016例,其中40～69岁共计6 596例,男性3 257例,女性3 339例,除去禁忌症、外出打工、拒绝参加者外,实际内镜筛查3 506例,筛查率53.2%.病理以WHO诊断为标准,将食管鳞状上皮轻度和中度不典型增生及食管-胃交界部轻度不典型增生划为低级别内瘤变人群,共诊断616例;内镜筛查无癌前病变和非癌诊断的作为正常人群共2478例.2008年6～9月对该队列人群进行随访核实.其中有174例失访,随访率95.0%.结果:低级别内瘤变人群和内镜病理正常人群随访分别为3 970.7人·年和16 120.0人·年,低级别内瘤变人群癌变率251.7/10万人·年,正常人群68.2/10万人·年;中位癌变时间分别是38个月和47个月.与正常人群比较,LIN癌变相对危险度RR=3.69(1.57～8.69),P=0.001.结论:低级别内瘤变人群是一组高危险人群,每年内镜复查是必要的.     

贲门脊根部黏膜形态异常的前瞻性研究

[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。     

731例食管上皮增生自然转归随访分析

 为了研究食管上皮增生的演变及其与食管癌的关系，对1973年食管细胞学普查发现为食管上皮增生的731例病人进行了随访复查．结果表明，重度增生癌变率为14.57%(22/151)；中度增生癌变率为6.52%(3/46)；轻度增生癌变率为5.81%(31/534)．重增癌变率和轻增癌变率相比，有有一显著差异(P＜0.01)．拉网复查的233人中，经由轻度增生，重度增生、癌发展的56人，占24%；稳定未变的93人夕占39.9%；由重增回转为轻增者18人．由重增、中增、轻增回转为正常者81人，回转率为34.7%在影响食管上皮癌变的诸因素中夕以长期消化道慢性病史与食管上皮增生癌变关系最为密切(P＜0.0l)．这说明，增生程度越重，癌变比例越大夕间隔时间越短，食管癌是由食管上皮增生演变而来，食管上皮重增是食管癌的癌前病变．预防食管癌应注重防治食管上皮增生和慢性消化道疾病．     

^18F-FDG PET显像在食管癌诊断中的临床意义

目的：探讨正电子发射型电子计算机断层(positron emission computed tomography，PET)显像在食管癌早期诊断以及临床分期中的临床应用价值。方法：23例食管癌患者，进行全身^18F-脱氧葡萄糖(^18F-fluorodeoxy-glucose，^18F-FDG)PET显像，并与外科手术或内镜活检病理结果和CT检查结果对照。结果：46倒患者中PET显像食管部位均有异常放射性浓聚灶，经病理确诊，46处食管浓聚灶均为食管癌原发病灶。其中28例为单发病灶，2例为食管多发灶，其余16例除食管原发病灶外，还有其他部位32个病灶，经临床和病理证实为远处转移病灶。与46例PET显像前CT结果相比较，PET共检出食管部位恶性病灶46例，检出率为100．0％，而CT仪检出34例，检出率为73．9％。46例中确诊有其他部位转移者18例，PET检出18例，检出率为100．0％，而PET显像前CT仅检出6例，检出率为33．3％。27例手术治疗者PET分期与临床病理分期一致，而常规检查对食管癌临床分期高估5例，低估12例，PET显像改变了这17例患者的临床治疗方案。结论：^18F-FDG-PET显像对食管癌的诊断、淋巴结和远处转移的分期、治疗方案的制定有重要的临床应用价值。     

食管及胃粘膜的内镜所见与病理组织学的比较

采用光导纤维内镜，观察８７８例３５岁以下的林县居民的食管及胃粘膜病变，对有内镜所见的各种病变均取材进行连续切片，光学显微镜观察，比较内镜所见图像的病理组织学特点，研究显示：（１）内镜所见溃疡、结节及肿物，镜下证实为癌占７０．７％；（２）糜烂病灶中，癌占１３．８％；（３）斑块病灶中，癌占４８％；（４）红区病灶中，癌占０．８４％，结果显示：除内镜所见肿物及溃疡以外，较大的糜烂及红区，特别是糜烂伴有斑块的区域，癌的可能性也较大。     

河南食管癌高发区同卵双胞胎食管黏膜组织病理学研究

[目的]分析河南食管癌高发区同卵双胞胎食管黏膜活检组织病理结果,进一步阐述遗传和环境因素对食管癌发生发展的影响。[方法]对双胞胎进行问卷调查,血型检查,并对其中112对自愿接受内镜检查者进行食管黏膜活检和组织病理学检查。[结果]接受内镜检查的112对双胞胎中,共检出食管鳞癌8对,其中双胞胎两人均患癌有4对,一致率为50%。食管不典型增生10对,其中双胞胎两人均为不典型增生1对,一致率为10%。[结论]遗传和环境因素在食管癌发生发展中均起重要作用。     

MDM2、P53和P27蛋白在食管鳞癌及其癌旁组织中的表达及其意义

背景与目的:探讨癌基因蛋白MDM2、抑癌基因蛋白P53以及细胞周期蛋白P27在食管鳞癌及其癌旁组织中的表达及其意义.材料与方法:采用免疫组织化学EnVision二步法(定性)检测85例食管癌存档蜡块及其癌旁黏膜中MDM2、P53和P27蛋白的表达;采用流式细胞仪(定量)检测上述3种蛋白在48例食管癌新鲜组织标本及其癌旁黏膜以及12例切缘相对正常黏膜中的表达.结果:从单纯性增生-轻度非典型增生-中度非典型增生-重度非典型增生-原位癌-浸润癌进展过程的变化,发现:定性和定量检测结果均显示P53蛋白在正常食管黏膜上皮中无表达,在食管癌变早期即出现P53蛋白的积聚;而MDM2、P27蛋白在正常黏膜上皮均有不同程度的表达,在癌变的晚期MDM2蛋白表达明显增加.结论:P53和P27蛋白表达的变化可能发生在食管癌形成早期,MDM2蛋白表达的变化可能发生在食管癌变的晚期.定性和定量2种方法联合检测能更客观和准确的探讨癌基因产物的表达及其临床意义.     

食管癌高发区居民口腔细胞学状况及其与食管脱落细胞学相关性的研究

  目的 以口腔脱落细胞学方法探讨食管癌高发区居民口腔黏膜病变和食管黏膜病变的可能关系。方法 对河北省磁县食管癌高发区2 674名30岁以上成年居民进行口腔脱落细胞学检查。并在双盲条件下对其中335人进行了食管脱落细胞学检查，对比分析其相关关系。结果 受检居民中口腔黏膜炎症检出较为普遍，口腔黏膜炎症发生率近30.00 %，各年龄组居民发生率随年龄增高而增加，56岁以上人群发生率达到50.00 %以上，而30～35岁组只有13.30 %。口腔黏膜上皮细胞增生病变的发生率比较低，仅占1.16 %。除炎症、增生等病变外，55.90 %的当地居民口腔黏膜涂片中可见真菌菌丝。口腔黏膜炎症居民食管黏膜增生病变的发生率明显高于口腔黏膜无炎症者，口腔黏膜炎症与食管黏膜增生病变有明显相关关系（P＜0.001）。结论 食管癌高发区居民口腔黏膜炎症发生率较高，口腔黏膜炎症与食管黏膜增生病变明显相关。     

Effect of added dietary calcium on esophageal epithelial-cell proliferation in subjects at high risk for esophageal cancer: A double-blind intervention study

A randomized double-blind intervention trial was carried determine whether oral calcium supplementation could lower the proliferation of epithelial cells of the esophagus. 41 subjects identified with precanceous lesions by histopathology were randomized to receive oral supplementation of their conventional diets with 0.6 g of calcium as calcium carbonate or placebo. Both at the entry to the study and at the end of the treatment, seven months later, the subjects were examined, with an emphasis on the frequency and distribution of proliferating epithelial cells of the esophagus. Patterns of cell proliferation was defined by dividing the esophageal epithelium into cell olumns oriented perpendicularly to the basal cell layer and by comparing the numbers and fractions of tritiated thymidine-labled epithelial cells in the various cell columns and cell compartments. Before dietary supplementation with calcium, the profile of proliferating epithelial cells in the esophageal compartments in calcium group is similar to that in the placebo group, which is comparable to that previously observed in subjects with high risk for esophageal cancer. Seven months after supplementation having been started, in calcium group, proliferation was significantly reduced and the profile of the esophageal columns approached to that previously observed in subjects at low risk for esophageal cancer, however, in the placebo group, the proliferation and profile maintain at the same level as that before supplementation. Our findings indicate that oral calcium supplementation induces a more quiescent equilibrium in epithelial-cell proliferation in the esophageal mucosa of the subjects at high-risk for esophageal cancer, similar to that observed in subjects at low risk.     

Barrett's esophageal cancer

Barrett's esophageal cancer is defined as carcinoma developing in Barrett's esophagus. The esophagogastric junction is located at the distal end of a network of fine longitudinal vessels, and the columnar epithelium existing above it is Barrett's mucosa. Barrett's mucosa, especially specialized columnar epithelium is considered as precancerous lesion, and malignant potential is examined in various ways. For the surveillance of malignant lesions from Barrett's esophagus, periodic endoscopic examination is necessary with chromoendoscopy or magnifying endoscopy. Treatment strategies are EMR and other endoscopic treatment for mucosal cancer, and surgical treatment for submucosal and advanced cancer. Several surgical modalities are employed depending on the stage of cancerous progression, the location of the cancer in Barrett's esophagus, and the length of Barrett's esophagus. There remain many unexplained problems in Barrett's esophagus and Barrett's cancer.     

A case of esophageal stricture due to metastatic breast cancer diagnosed by endoscopic mucosal resection

Metastasis of breast cancer to the esophagus has been reported but is rare. It is often difficult to diagnose metastases of breast cancer to the esophagus because they are often located in the submucosa and covered with normal mucosa. Although several methods have been reported in order to obtain specimens for pathological diagnosis, the adverse effects including bleeding and perforation were considerable problems. We report a case of a patient with esophageal stricture due to metastatic breast cancer to the esophagus. Pathological diagnosis was successfully obtained using endoscopic mucosal resection of the esophagus.     

Co-existence of early esophageal carcinoma and leiomyoma: a case report

There have been several reports of co-existing esophageal squamous cell carcinoma and esophageal submucosal tumor. However, there is no previous report describing a submucosal tumor located within an area of early esophageal cancer. This report presents the case of a 64-year-old man who developed early esophageal cancer with leiomyoma situated within the lesion in the upper third of the esophagus. Since leiomyoma existed within the area of the esophageal cancer, it was misdiagnosed as a component of esophageal cancer and the depth of esophageal cancer invasion was overdiagnosed by endoscopic ultrasonography. Therefore, surgery was chosen as treatment for esophageal cancer. If the leiomyoma had been diagnosed correctly as a submucosal tumor by endoscopy and endoscopic ultrasonography, an endoscopic mucosal resection would have been the therapeutic procedure of choice for an esophageal tumor.     

饮食补钙对人食管上皮癌前病变的影响：双盲干预试验研究

A randomized double blind intervention trial was carried out in Huixian County Henan Province, a high risk area for esophageal cancer, to observe the effect of oral calcium supplementation on esophageal precancerous lesions. Two hundred and fourteen cases with basal cell hyperplasia and 40 with dysplasia of the esophagus aged 25-75 randomly received daily oral supplementation of 600 mg calcium or placebo for 7 months. In the calcium supplementation group, the basal cell hyperplasia and dysplasia of the esophagus were significantly improved and the profile of esophageal epithelial proliferation cells labeled with 3H-TdR approached that of the normal subjects in low risk area for esophageal cancer. The results indicate that calcium supplementation can inhibit basal cell hyperplasia and dysplasia of the esophageal epithelium in high risk area for esophageal cancer. The mechanism of interruption of esophageal precancerous lesions by calcium is discussed.     

Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma.

Unlike the stomach, the esophageal mucosal layer has abundant vessels. To study the histopathologic character of cancer of the esophagus in comparison with that of stomach, the histologic findings (such as vascular or lymphatic permeation and lymph nodal involvement of cancer) were surveyed in 52 lesions of superficial esophageal carcinoma in which carcinoma invasion was limited to the submucosal layer, 448 cases of so-called early gastric carcinoma in which the carcinoma invasion was limited to the submucosal layer, and 109 cases of gastric carcinoma invading the proper muscle layer (PM-carcinoma). With respect to lymph node metastasis and lymphatic and vascular permeation, there was a particularly high incidence of carcinoma extending to the submucosal layer (SM-carcinoma) of the esophagus and a similar high incidence of PM-carcinoma of the stomach. Carcinoma limited to the mucosal epithelium and mucosal layer of the esophagus (MM-carcinoma) has an incidence similar to carcinoma in the mucous membrane and SM-carcinoma of the stomach, respectively. Thus, the cases in which carcinoma invasion was limited to the muscle layer of the mucosa of the esophagus were shown to have a prognosis similar to that of so-called early carcinoma of the stomach.     

Secondary prevention of esophageal cancer--intervention on precancerous lesions of the esophagus

In 1983, intervention of precancerous lesion of esophagus was undertaken in the high risk area of esophageal cancer, Heshun Village, Linxian County. It had been expected that cancerous degeneration rate of esophageal dysplasia should be reduced by 50% so as the prevention of esophageal cancer could become possible. 6758 subjects of the general population aging from 40 to 65 were examined by esophageal exfoliative cytology, 1729 had marked dysplasia and 2411 had mild dysplasia of esophageal epithelium. Those with marked dysplasia were randomized into 3 groups to take their respective medication: antitumor B (Chinese herbs); retinamide (4-Ethoxycarbophenylretinamide) and placebo. The subjects with mild dysplasia were divided randomly into 2 groups for treatment by riboflavin and placebo. 95% of the subjects had taken 90% or more of the total medication for 3 years, at the end of which they were reexamined by esophageal exfoliative cytology. The reexamination rate was 94.1%. The incidence of esophageal cancer in the antitumor B group (3.9%) was reduced by 53% as compared with that of the placebo group (8.3%). This difference had statistical significant (means 2 = 7.672, P less than 0.05). The incidence of esophageal cancer in retinamide and riboflavin groups were reduced by 33.7% and 19% as compared with those of the control groups. The regression rate of dysplasia in the treatment groups were increased than that of the control groups. The above results showed that our hypothesis about the secondary prevention of esophageal cancer is correct. The intervention of precancerous lesion of the esophagus is effective in the prevention of esophageal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Micronuclei in esophageal cells of Chinese youths in a high-incidence area for esophageal cancer in China.

An epidemiologic survey among 538 young persons between 15 and 26 years of age in a high-risk area for esophageal cancer in the People's Republic of China revealed a high prevalence of esophagitis. Histologically confirmed very mild, mild, and moderate esophagitis was observed in 31.6%, 10.7%, and 1.1% of 354 male and 30.4%, 4.3%, and 1.1% of 184 female subjects. The prevalence of micronuclei in esophageal smears was assayed in a subsample to investigate its possible association with esophagitis and with risk factors for esophageal lesions. Of the 186 subjects, 2.7% had mild or moderate esophagitis, 19.9% had very mild esophagitis, and 77.4% were normal. The frequency distribution of micronucleated cells in the esophageal mucosa was similar for the three diagnostic groups. Mean percentages of micronucleated cells did not differ by diagnosis of esophagitis, household status, current smoking status, presence of oral leukoplakia, or consumption of burning hot beverages or fresh fruit. Higher mean percentages were observed in the older age group of both sexes, but the difference was not statistically significant. The results suggest that if esophagitis is considered an important precursor state in the development of esophageal cancer, the scoring of micronuclei does not appear to be an efficient test for mild forms of esophagitis.     

Precursor lesions of esophageal cancer in high-risk populations in Henan Province, China

This report discusses precancerous changes in the esophageal mucosa from three points of view: the histopathologic features of the esophageal mucosa in persons known to be at high risk for esophageal carcinoma (EC); the histopathologic features of the esophageal mucosa of asymptomatic persons randomly selected from areas at high and low risk for EC; and a prospective follow-up of a randomly examined group to determine the impact of esophagitis and dysplasia upon subsequent development of EC. Esophagitis was commonly found at endoscopic examination, but there was no difference in frequency of esophagitis in the randomly selected subjects from high-risk and low-risk areas. Although one third of patients with dysplasia developed cancer over a follow-up period of 30 to 78 months, only 4% of those with esophagitis alone developed EC. The authors conclude that dysplasia, diagnosed by cytologic or histologic examination, is a precancerous state, and that esophagitis is a nonspecific pathologic condition of the esophagus, but moderate and severe types of chronic esophagitis might create an environment favorable for the development of esophageal carcinoma.