Hagen J A
Division of Cardiothoracic Surgery, University of Southern California, Los Angeles 90033, USA.
Semin Thorac Cardiovasc Surg. 1997 Jul;9(3):285-9.
Barrett's esophagus is a metaplastic change in the mucosal lining which represents a peculiar form of healing in response to the chronic injury due to gastroesophageal reflux. It has been recognized that this change is associated with an increased risk of developing esophageal adenocarcinoma. Several factors have been shown to identify the patients who are at particular risk for carcinoma, the most importance of which is the development of dysplasia. As a result, management of patients with Barrett's esophagus must include careful endoscopic surveillance with histological examination of the biopsies by two independent experienced pathologists. Patients with low-grade dysplasia require complete control of reflux and careful endoscopic surveillance. Because the majority of patients with high-grade dysplasia will have co-existent adenocarcinoma, and because of difficulties in differentiating high-grade dysplasia from invasive adenocarcinoma, esophagectomy is the treatment of choice for these individuals. This approach has been shown to result in a significant improvement in survival in patients with esophageal cancer identified under surveillance.
巴雷特食管是黏膜内衬的一种化生改变，它代表了对胃食管反流所致慢性损伤的一种特殊愈合形式。人们已经认识到这种改变与食管腺癌发生风险增加有关。已证实有几个因素可用于识别患癌风险特别高的患者，其中最重要的是发育异常的出现。因此，巴雷特食管患者的管理必须包括由两名经验丰富的独立病理学家对活检组织进行组织学检查的仔细内镜监测。低级别发育异常的患者需要完全控制反流并进行仔细的内镜监测。由于大多数高级别发育异常的患者会同时存在腺癌，并且由于难以将高级别发育异常与浸润性腺癌区分开来，因此食管切除术是这些患者的首选治疗方法。这种方法已被证明可显著提高在监测中发现的食管癌患者的生存率。
