【作者】 杨小荣；

【导师】 杨力；

【作者基本信息】 宁夏医科大学 ， 内科学， 2009， 硕士

【摘要】 目的对宁夏医科大学附属医院自1975年11月11日,至2006年12月31日32年间胃镜室食道癌检出率以及检出的食道癌病人一般情况、病变部位、病理类型、总体病理类型变化趋势进行临床流行病学研究。方法查阅宁夏医科大学附属医院胃镜室1975年11月11日～2006年12月31日32年间胃镜检查记录,统计检查人次数,记录胃镜下诊断为食道癌病人的姓名、性别、年龄、民族、病变部位,翻阅病理科病理检查记录,核对姓名、性别、年龄,详细记录病理诊断为食道癌病人的一般情况及病理类型,按诊断时间分为四组,进行统计学分析。结果32年间我院胃镜室共进行96727人次胃镜检查,检出食道癌1616人,食道癌检出率1.67%,按10年统计32年间食道癌检出率无变化趋势,食道癌男女比例为2.58∶1,以40～65岁之间的病人为多(占59.65%);病变部位以食道中段为主(占70.7%),下段次之,上段最少;病理类型仍以鳞癌为主,占88.2%,腺癌占11.8%;汉族、回族、蒙古族之间食道鳞癌和腺癌发病没有差异;32年来食道下段腺癌的构成比渐增高。结论宁夏医科大学附属医院胃镜室32年间食道癌检出率无明显变化趋势,提示宁夏周边地区该病发病率无变化;食道癌以40～65岁年龄段好发,65岁以上人群食道癌发病率有增加趋势;不同年龄段腺癌发病没有差异;宁夏周边地区汉族、回族、蒙古族食道鳞癌、腺癌发病没有差异;食道下段腺癌发病有增加趋势。目的研究Lugol’s液进行食道染色联合MUC2检测对Barrett食道的诊断价值。方法检查前确认患者无碘过敏史,对胃镜下初步诊断为Barrett食道的患者,随机分为两组,A组为对照组,在紧靠齿状线下方、齿状线舌形突出、齿状线上岛形橘红色粘膜处取活检2～4块,送常规病理检查;B组为实验组,对胃镜下初步诊断的病例,行2% Lugol’s液10～20ml食道染色,1～3分钟食道粘膜迅速染色,在食道不着色区取活检(靶向活检)2～4块送常规病理检查,同时行免疫组化检测MUC2表达情况。结果A组常规病理确诊为Barrett食道12例,其中3例为肠化型Barrett食道;B组病理诊断为Barrett食道21例,常规病理诊断7例为肠化型,病理诊断的BE中有13例MUC2阳性表达,两组BE检出率之间比较,χ~2=4.4,P=0.036<0.05,差异有显著性;两组肠化型BE检出率之间比较,χ~2=7.232,P=0.007<0.05,差异有显著性。结论Lugol’s液食道染色进行靶向活检可以提高Barrett食道的诊断率,MUC2检测显著提高了肠化型BE的诊断率。更多还原

【Abstract】 Objective To analyze the clinical charater and pathological type of the patients with esophageal cancer.from 1975 to 2006, in The Affiliated Hospital of Ningxia Medical University.Methods All the cases were divided into 4 groups according to the different time orders from 1975-2006, in the endoscopy unit of the Affiliated Hospital of NingXia Medical University. The gender, age, nationality, lesion, pathological type of patients were collected and statistically analyzed.Result The 96727 cases were examined by endoscopy and 1616 esophageal cancer were found.The incidence rate of esophageal cancer was 1.76%. Male vs famale was 2.58.The more cases were between 40 and 65 years old. And the more lesion area located in the middle esophagus. The squamous cell carcinoma was 88.2% in all the type of esophageal carcinoma. Most of the esophageal adenocarcinoma were found in the distal esophagus and the incidence rate is 11.8%. And it was found the distal esophageal adenocarcinoma increased through the years.Coclusion There were no significant difference (P>0.05) in the detective rate of esophageal cancer between the 4 groups.And there were also no significant difference (P>0.05) between the ages and nationality in incidence of adenocacinoma. There was an increased incidence of esophageal cancer with increasing age.It was found the distal esophageal adenocarcinoma increased through the years. Objective To study the expression of MUC2 combines of Lugol’s solution staining in the patients with Barrett’s esophagus.Methods All the 44 Barrett’s esophagus were diagnosed by the endoscopy.They were randomized into two groups. Group A(control group) were 20 cases, 2～4 biopsies were taken from orange areas of esophagus. Group B(experiment group)were 24 cases stained with 10～20ml Lugol’s solution first.After 1～3min, 2～4 biopsies were taken from unstained areas . The expression of the MUC2 were detected by immunohistochemistry in the group B.Results 12 cases in the group A were confirmed Barrett’s esophagus by pathologist, and 3 cases were found the intestinal metaplasis in the Barrett’s esophagus. 21 cases in the B group were were confirmed Barrett’s esophagus by pathologist, and 7 cases were found the intestinal metaplasis in the Barrett’s esophagus.And the MUC2 were positive in 13 cases. The detectiive rate of Barrett’s esophagus was significant difference between group A and group B (χ~2=4.4, P=0.0362<0.05). And the detection of the intestinal metaplasia was also was significant difference between group A and group B (χ~2=7.232, P=0.007<0.01).Conclusion The Lugol’s solution staining could increase the diagnostic rate of Barrett’s esophagus, and combination of detecting the expression of MUC2 can increase the diagnostic rate of the intestinal metaplasia.更多还原