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[上消化道疾病中的性别医学]

[Gender medicine in diseases of the upper gastrointestinal tract].

作者信息

Plum Patrick S, Mönig Stefan P, Gockel Ines, Keller Gisela, Ott Katja

机构信息

Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20 Haus 4, 04103, Leipzig, Deutschland.

Service de Chirurgie Viscerale, Hopitaux Universitaires de Genève, Genf, Schweiz.

出版信息

Chirurgie (Heidelb). 2024 Sep;95(9):685-695. doi: 10.1007/s00104-024-02158-y. Epub 2024 Aug 9.

Abstract

Benign and malignant diseases of the upper gastrointestinal tract show gender-specific differences. The frequent gastroesophageal reflux disease is a prime example: men have an erosive reflux disease more often than women and are also younger at the time of onset. The rate of progression to a metaplastic Barrett's esophagus is also higher in men. In the case of achalasia, there are indications that surgical treatment by laparoscopic Heller's myotomy and semifundoplication 180° according to Dor leads to a markedly better improvement in the symptoms in women compared to men, although they showed a more pronounced dilation of the tubular esophagus. The female hormone status influences the localization and histopathology of adenocarcinoma of the esophagogastric junction and gastric carcinoma. Premenopausal and postmenopausal carcinomas differ significantly in women. In addition, high microsatellite instability (MSI high) is more frequent in women and is associated with a generally significantly better prognosis. The MSI high gastric carcinomas of women show better survival than MSI high carcinomas of men. The future inclusion of gender-specific aspects in studies of the upper gastrointestinal tract is desirable in order to generate adequate data and to enable differentiated treatment stratification in the future.

摘要

上消化道的良性和恶性疾病存在性别差异。常见的胃食管反流病就是一个典型例子:男性患糜烂性反流病的频率高于女性,且发病年龄也更年轻。男性进展为化生的巴雷特食管的比例也更高。在贲门失弛缓症方面,有迹象表明,与男性相比,采用腹腔镜下根据多尔法进行的180°赫勒肌切开术和半胃底折叠术进行手术治疗,女性的症状改善明显更好,尽管她们的管状食管扩张更为明显。女性激素状态会影响食管胃交界腺癌和胃癌的定位及组织病理学。绝经前和绝经后女性的癌症有显著差异。此外,高微卫星不稳定性(MSI高)在女性中更为常见,且通常与显著更好的预后相关。女性的MSI高胃癌比男性的MSI高胃癌生存率更高。未来在上消化道研究中纳入性别特异性因素是可取的,以便生成足够的数据,并在未来实现差异化的治疗分层。

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