大连【201609论著】胃食管结合部早期癌53例内镜特征分析-大连春柳胃肠医院

大连【201609论著】胃食管结合部早期癌53例内镜特征分析

来源:大连春柳胃肠医院时间：2022-10-14 01:30

【201609论著】胃食管结合部早期癌53例内镜特征分析

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【摘要】

目的研究53例经术后病理证实的胃食管结合部（GEJ）早期癌患者的内镜下特征，探讨提高内镜下GEJ早期癌的诊断方法和技巧。

方法对2011年11月至2015年7月期间于郑州大学第二附属医院消化内镜中心和解放军第152中心医院消化内镜室检查时发现、并经病理证实的53例GEJ早期癌的患者资料进行回顾性分析，对其普通白光内镜下特征、窄带放大内镜下特征及病理学特征进行汇总分析。

结果 GEJ早期癌中，以Siewert 2型为主，占67.9％（36／53），其中58.3％（21／36）位于贲门下区后壁，发生部位差异有统计学意义（P=0.028）。内镜下形态以0-Ⅱ型病灶为主，占94.3％（50／53），Siewert 2型病变中0-Ⅱ型占97.2％（35／36），多需倒镜观察其全貌，少部分需结合正镜观察。普通白光胃镜下表现为黏膜潮红者90.6％（48／53），粗糙79.2％（42／53），糜烂35.8％（19／53）。获得窄带放大内镜图片者30例，窄带放大内镜见病灶黏膜下微血管不规则或消失96.7％（29／30），上皮微细结构和腺管开口不规则或消失90.0％（27／30），病灶边界线清晰86.7％（26／30）。Siewert 1、2、3型伴Barrett食管分别为83.3%（5／6）、11.1％（4／36）和9.1％（1／11），均为短段或超短段Barrett食管，Siewert 1型与2型（P=0.001）或3型（P=0.011）间差异有统计学意义。Siewert 1、2、3型伴肠上皮化生分别为16.7%（1／6）、75.0％（27／36）和63.6％（7／11），1型与2型间差异有统计学意义（P=0.011）。

结论 GEJ早期癌多见Siewert 2型，形态以0-Ⅱ型病灶为主，贲门下区后壁多见，往往需要正镜结合翻转胃镜才能观其全貌；普通白光下病变多表现为黏膜潮红、粗糙、糜烂；窄带放大内镜多见黏膜微细结构、腺管开口及黏膜下微血管不规则或消失，病灶边界线清晰；Siewert 1型多伴Barrett食管，Siewert 2、3型多伴肠上皮化生。

【关键词】内窥镜检查；食管胃接合处；早期癌；窄带成像

Endoscopic characteristics of the early gastroesophageal junctional cancer： an analysis of 53 cases

Cao Zhibo， Zhao Zhiguo， Shen Minqiang， Cui Jing， Liu Chao， Liu Xia， Li Gui， Huang Yanling， Ren Jingli， Hu Guiming， Li Congyang.

Department of gastroenterology， The Second Affiliated Hospital of Zhengzhou University， Zhengzhou 450014， China

Corresponding author: Zhao Zhiguo， Email：zzghappy@eyou.com

【Abstract】

Objective To investigate the endoscopic characteristics of early gastroesophageal junctional（GEJ） cancer to improve the diagnostic procedure and techniques of endoscopy.

Methods Data of 53 cases were retrospectively analyzed which were endoscopically and histologically diagnosed as early GEJ cancer in the gastrointestinal endoscopy center of the Second Affiliated Hospital of Zhengzhou University and No. 152 hospital of The PLA from November 2011 to July 2015. The lesion characteristics， features of white light endoscopy（WLE） and magnifying endoscopy with narrow band imaging（ME-NBI） and the clinicopathological features were analyzed.

Results In early GEJ cancer， 67.9％（36／53） were classified as Siewert type 2， and 58.3％（21／36） located in the posterior wall below cardiac region（P=0.028）. The main endoscopic type were Type 0-II（94.3％， 50／53）， and Type 0-II accounted for 97.2％（35／36） of Siewert type 2 lesions. The lens barrel need to be reversed to view the whole pictures of Type0-II lesions， and positive lens barrel were needed in a small number of lesions. The lesion mucosa showed flushing（90.6％， 48／53）， roughness（79.2％， 42／53）， erosion（35.8％， 19／53） under the WLE. The submucosal microvessel were irregular or disappeared in 96.7％（29／30）， the epithelial microstructure and pit patterns were irregular or disappeared in 90.0％（27／30）, and boundaries of 86.7％（26／30） lesions were clear under the ME-NBI. The Barrett esophagus accompanied with Siewert type 1， 2 and 3 accounted for 83.3%（5／6）， 11.1％（4／36） and 9.1％（1／11） respectively with significant difference（P=0.011）. The ratio of the intestinal metaplasia with Siewert type 1， 2 and 3 lesions were 16.7%（1／6）， 75.0％（27／36） and 63.6％（7／11） respectively， and there was significant difference between type 1 and type 2（P=0.011）.

Conclusion The Siewert type 2 is more common among the early GEJ cancer. Most of the lesions are shown the Type 0-II and located in the posterior wall below cardiac region. The mucosa lesions appear flushing， rough， erosion under WLE. The submucosal microvessel， epithelial microstructure and pit patterns appear irregular or disappeared， and lesions boundaries are clear under ME-NBI. Siewert type 1 tends to be complicated with Barrett esophagus， and Siewert type 2 and 3 tend to be complicated with intestinal metaplasia.

【Key words】Endoscopy；Esophagogastric junction；Early cancer；Narrow band imaging