Clark G W, DeMeester T R
Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Ann Chir Gynaecol. 1995;84(2):139-44.
Barrett's esophagus is a premalignant metaplastic change in the lining of the distal esophagus. It represents a peculiar form of healing which can occur at any time in patients with reflux esophagitis. Ninety percent of patients with Barrett's esophagus have a mechanically defective lower esophageal sphincter and 93% have abnormal esophageal acid exposure on 24 hour esophageal pH monitoring. Barrett's esophagus should be considered in all patients undergoing endoscopy for symptoms of reflux disease and is confirmed when any biopsy shows the presence of specialized intestinal metaplasia, irrespective of the macroscopic appearances of the distal esophagus. An anti-reflux procedure is indicated for patients with Barrett's esophagus since it is highly effective in controlling reflux symptoms, healing the associated esophagitis, prevents repetitive injury of the Barrett's epithelium, and is more effective than medical therapy in the long term. Annual endoscopic surveillance with multiple biopsy sampling of the esophageal mucosa is indicated after the antireflux repair. Identification of high grade dysplasia heralds the development of invasive cancer and offers the surgeon an opportunity to intervene. Despite extensive endoscopic sampling of the esophageal mucosa the differentiation between high grade dysplasia and invasive adenocarcinoma is unreliable. Esophagectomy remains the treatment of choice for patients with high grade dysplasia. Barrett's adenocarcinoma can be cured by en bloc esophagectomy in selected patients with early disease.
巴雷特食管是远端食管黏膜的一种癌前化生改变。它代表了一种特殊的愈合形式，可发生于反流性食管炎患者的任何时候。90%的巴雷特食管患者存在食管下括约肌机械性缺陷，93%的患者在24小时食管pH监测中显示食管酸暴露异常。对于所有因反流性疾病症状接受内镜检查的患者，均应考虑巴雷特食管，当任何活检显示存在特殊的肠化生时即可确诊，而不论远端食管的宏观表现如何。对于巴雷特食管患者，抗反流手术是必要的，因为它在控制反流症状、治愈相关食管炎、防止巴雷特上皮反复损伤方面非常有效，且从长期来看比药物治疗更有效。抗反流修复术后，建议每年进行内镜监测，并对食管黏膜进行多次活检取样。高级别异型增生的发现预示着浸润性癌的发生，为外科医生提供了干预的机会。尽管对食管黏膜进行了广泛的内镜取样，但高级别异型增生与浸润性腺癌之间的鉴别并不可靠。食管切除术仍然是高级别异型增生患者的首选治疗方法。在部分早期巴雷特腺癌患者中，整块食管切除术可治愈该病。
