摘要：目的：通过内镜下早期食管癌表现与临床病理对比，加深对内镜下早期食管癌的认识，提高早期食管癌早期发现率。方法：回顾我院内镜下治疗或手术后百色地区30例患者经病理诊断为早期食管癌的临床资料、镜下特点及病理特征。结果：男性19例，女性11例，男女比例为1.73：1，发病高峰年龄为50-69岁22例（占73.3%），上段2例（6.7%），中段22例（73.3%），下段6例（20%）。内镜Paris分型: 0-I型（隆起型）、0-IIa型（浅表隆起型）、0-IIb（浅表平坦型）、0-IIc型（表浅凹陷性）、0-III型（凹陷型）分别为：3.3%、13.3%、56.7%、20%、6.7%，日本食道学会将早期食管癌上皮内乳头状毛细血管襻（intrapapillary capillaryloop，IPCL）放大内镜分类分为（A、B分型）：其中B1型：17例、B2型11例，B3型：2例。病理分型：鳞癌（15例）、重度不典型增生/原位癌（14例46.7%），腺癌（1例），其中粘膜下层浸润占5例，余均为原位癌或粘膜内癌。结论：早期食管癌好发50-69岁男性，食管中段为主，内镜下以浅表型多见、病理鳞癌常见，常规内镜检查联合NBI+放大内镜是发现早期食管癌重要的手段。

关键词：早期食管癌；内镜检查；临床病理；巴黎分型

The endoscopic and clinicopathologic characteristics of 30 cases with early esophageal carcinoma in baise area

Jiang Qi ,Hu Jing ,Su Jianwei

(Department of gastroenterology，Affiliated Hospital of YouJiang Madical University for Nationalities.BaiSe City Guangxi Zhuang Autonomous Region,533000)

[Abstract] Objective：To explore the endoscopic and clinicopathologic characteristics of early esophageal carcinoma and raise the diagnosis rate of it.Methods A retrospective analysis was made in the 30 cases of the early esophageal carcinoma in baise area proved by endoscopic submucosal dissection(ESD)or operation in our hospital. Results Of the 30 cases(19 men and 11 women),the ratio of male/female was1.73:1.the peak incidence of age were from 50to 69 years.The ratio of the upper esophagus，middle part and lower part was 6.7%,73.3% and 20%，respectively．As for the Paris macrosopic type classification，the percentage of protruding(0-I),slightly elevated(II-a),flat(II-b),depressed(II-c)andexcaveted(0-III)was3.3%,13.3%,56.7%,20%and6.7%,respective.these two exemplary classifications as the Japanese Classification of Magnifying Endoscopy for Early Squamous Cell Carcinoma:A、B. Among them,17 B1 type intrapapillary capillary loop (IPCL) patterns,11 B2type IPCL patterns,2 B3 type IPCL patterns,The ratio of the hight grade intraepithelial neoplasia/ carcinoma in situ,the adenocarcinoma and the squamous carcinoma was46.7%,50%and3.3%,respectively,14 cases of the hight grade intraepithelial neoplasia/ carcinoma,15 cases of intramucosal carcinoma,5 cases of submucosal carcinoma. Conclusion Early esophageal carcinoma often occurs in males of 50 to 69 years old,and median esophagus is the predilection site. the Paris macrosopic type classification:flat(II-b),depressed(II-c)and squamous carcinoma are its main type.Gastroscopic inspection combined with biopsy is an important method in detecting early esophageal cancer.

[Key words] Early esophageal carcinoma；Endoscopy；Clinical pathology；the Paris classification

食管癌在全球癌症发病率中排第八位，癌症相关死亡率排第六位^[1]。5年生存率在15%-20%，是消化道肿瘤中预后较差的^[2]。食管癌患者约80%发生在发展中国家。我国也是食管的高发地之一，同时超过半数的食管癌相关的病死患者发生在中国^[3]。但早期食管癌5年生存率可达95-100%^[4],早期食管癌起病较隐蔽，多无临床症状，一旦内镜检查漏诊，往往使患者失去最佳治疗机会。食管癌可以在较长时间内保持相对稳定的早癌状态 ^[5] , 癌前病变发展到食管癌年限约10年左右, 因此内镜医师加深对早期食管癌的认识，做到早诊早治是提高食管癌疗效的途径。