贲门失弛缓症患者比健康人发生食管鳞状细胞癌的风险增加(高达140倍)。[75]Brucher BL, Stein HJ, Bartels H, et al. Achalasia and esophageal cancer: incidence, prevalence, and prognosis. World J Surg. 2001;25:745-749.http://www.ncbi.nlm.nih.gov/pubmed/11376410?tool=bestpractice.com 一项随访超过10年的研究表明,67例接受贲门肌切开术的患者有3例发展成为鳞状细胞食管癌。[56]Csendes A, Braghetto I, Burdiles P, et al. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg. 2006;243:196-203.http://www.ncbi.nlm.nih.gov/pubmed/16432352?tool=bestpractice.com 一项研究结果表明,贲门失弛缓症患者患食管鳞状细胞癌和腺癌的风险都比健康人增加10倍。[76]Zendehdel K, Nyrén O, Edberg A, et al. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol. 2011;106:57-61.http://www.ncbi.nlm.nih.gov/pubmed/21212754?tool=bestpractice.com 目前认为这主要是由于残留在食管中的食物和其他有毒混合物缓慢破坏食管黏膜所致。[77]Dunaway PM, Wong RK. Risk and surveillance intervals for squamous cell carcinoma in achalasia. Gastrointest Endosc Clin N Am. 2001;11:425-434.http://www.ncbi.nlm.nih.gov/pubmed/11319071?tool=bestpractice.com 确诊通常比较晚,因为患者已经有一定程度的吞咽困难,而且在一个扩张的食管中任何阻塞性的损伤必需要足够大才能引发症状。[75]Brucher BL, Stein HJ, Bartels H, et al. Achalasia and esophageal cancer: incidence, prevalence, and prognosis. World J Surg. 2001;25:745-749.http://www.ncbi.nlm.nih.gov/pubmed/11376410?tool=bestpractice.com[77]Dunaway PM, Wong RK. Risk and surveillance intervals for squamous cell carcinoma in achalasia. Gastrointest Endosc Clin N Am. 2001;11:425-434.http://www.ncbi.nlm.nih.gov/pubmed/11319071?tool=bestpractice.com 预后较差;然而,内镜监测并不是标准的诊疗常规。[77]Dunaway PM, Wong RK. Risk and surveillance intervals for squamous cell carcinoma in achalasia. Gastrointest Endosc Clin N Am. 2001;11:425-434.http://www.ncbi.nlm.nih.gov/pubmed/11319071?tool=bestpractice.com 在一项对治疗贲门失弛缓症的医师进行的调查中,82% 的医师认为贲门失弛缓症会使癌症的终生发病风险增高,89% 的医师支持每 2-5 年进行一次常规筛查。[76]Zendehdel K, Nyrén O, Edberg A, et al. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol. 2011;106:57-61.http://www.ncbi.nlm.nih.gov/pubmed/21212754?tool=bestpractice.com
食管肿瘤
|