目的 了解我国人食管末端和胃-食管连接处的肠化生（IM）及异形增生和肿瘤的发病状况．齿状线（SCJ）位置和反流性食管炎（RE）的关系。方法 调查记录391例患者的症状、胃镜下RE的表现、井根据SCJ的位置分为3组。其中。胃镜下见齿状线上移≥3cm为A组，<3cm为B组。齿状线和GEJ同一水平的为C组。每例患者均于齿状线远端活检送病理检查。结果 A、B、C3组IM发生率分别为26.53%、33.85%、34.00%；FIM的发生在40岁以后随着年龄增长逐渐增加，男女之间无差异；361例患者中共诊断异型增生12例（轻度7例、中重度5倒）、贲门癌16倒、食管腺癌1例；A、B、C3组RE的发病率分别为57.14%、22.83%、12.00%。结论 1.胃镜下提示为LSBE、SSBE和GEJ三组间的IM发生率无显著差异；2.应重视食管末端及胃一食管连接处异型增生的诊断；3.贲门癌发病远高于食管腺癌。

为了再度评价卢戈氏液内镜下食管粘膜染色对食管早期癌和表浅癌的诊断价值，对144例食管早期癌可疑患者进行食管粘膜染色，并对不染区多点活检送病理检查，其中131例为肉眼无可疑病灶者，94例没有任何食管症状。诊断结果：食管癌7例（手术证实粘膜癌2例，粘膜下癌2例）；不典型增生10例（轻度5例，中度3例，重度2例）；单纯上皮增生伴或不伴慢性炎症25例；结核1例。并发现有食管症状者碘不染区出现率明显高于无食管症状者（P＜0.05）。结论：内镜下卢戈氏液染色有助于食管早期癌、表浅癌及癌前病变的诊断，并帮助鉴别诊断。

AIM: To study the prevalence of Barrett's esophagus in Chinese and its correlation with gastroesophageal reflux. METHODS: This study was carried out in a large prospective series of 391 patients who had undergone upper endoscopy. The patients were divided into 3 groups according to the position of squamocolumnar junction (SCJ). Reflux esophagitis (RE) and its degree were recorded. Intestinal metaplasia (IM) in biopsy specimen was typed according to histochemistry and HE and alcian blue (pH2.5) staining separately. Results correlating with clinical, endoscopic, and pathological data were analysed. RESULTS: The prevalence of IM endoscopically appearing Long-segment Barrett’s Esophagus (LSBE) was 26.53%, Short-segment Barrett’s Esophagus (SSBE) was 33.85%and gastroesophageal junction (GEJ) was 34.00%. IM increased with age of above 40 years old and no difference was found between male and female. Twelve were diagnosed as dysplasia (7 low-grade, 5 high-grade), 16 were diagnosed as cardiac adenocarcinoma and 1 as esophageal adenocarcinoma. The more far away the SCJ moved upward above GEJ, the higher the prevalence and the more severe the RE were. CONCLUSION: There was no difference of the prevalence of IM in different places of SCJ, and IM increased with age of above 40 years old. It is important to pay attention to dysplasia in the distal esophagus and gastro-esophageal junction, and adenocarcinoma is more common in cardia than in esophagus. BE is a consequence of gastroesophageal reflux disease.

目的 探讨西安地区内镜检出并经病理证实的上消化道癌症的临床流行病学特点。方法 选择1991年1月至2002年12月于西安市三所大型医院进行胃镜检查并经病理确诊的上消化道癌症患者，对其临床、病理、内镜及流行病学特征进行分析。结果 12年来上消化道癌症总检出率为8.135，其中食管癌检出率3.42%，贲门癌检出率1.44%，非贲门部胃癌检出率3.26%，十二指肠癌检出率0.01%。12年来食管癌和胃癌的检出率虽有一些波动，但呈明显下降趋势（P=0.000），贲门癌呈现出较为平缓的上升趋势（P=0.000）。贲门癌的男女性别比为6.29：1，远较胃癌和食管癌为高（2.92：1和3.09：1,P=0.000）。食管鳞癌和腺癌构成无明显变化（P=0.562），食管腺癌没有明显的升高趋势（P=0.557）。结论 西安地区食管癌居上消化道癌症之首；12年来胃癌、食管癌的检出率明显下降，贲门癌的检出率呈明显升高趋势；贲门癌为不同于食管癌和胃癌的独立疾病。