ACHALASIA COMPLICATED BY ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - A PROSPECTIVE-STUDY IN 195 PATIENTS
ACHALASIA COMPLICATED BY ESOPHAGEAL SQUAMOUS-CELL CARCINOMA - A PROSPECTIVE-STUDY IN 195 PATIENTS
复制标题
作者：
MEIJSSEN, MAC;TILANUS, HW;ONG, GL
为了确定贲门失弛缓症患者食管癌的发病率，并建立内镜监测的有效性，前瞻性研究了1973年至1988年期间在我们机构接受气囊扩张治疗的195例贲门失弛缓症患者（90例男性和105例女性，平均年龄52岁）。所有患者均未行心肌切开术。随访874人年。在此期间，3例患者发生食管鳞状细胞癌。诊断食管癌的平均年龄为68岁（37岁、77岁和89岁）。吞咽困难发作和肿瘤诊断之间的平均时间为17年（19、28和5年）;贲门失弛缓症和癌症诊断之间的平均间隔为5.7年（5、8和4年）。该系列中食管鳞状细胞癌的发病率（每年3.4/1000例患者）显著高于使用荷兰人群年龄和性别特异性发病率数据的统计学预期发病率（每年0.104/1000例患者）（泊松统计：p <0.001）。因此，贲门失弛缓症患者发生食管鳞状细胞癌的风险增加了33倍。定期内窥镜检查显示了在两例病例中检测早期食管癌的潜力，但需要更长时间随访的更大规模研究来确定内窥镜筛查在改善发展为食管鳞状细胞癌的贲门失弛缓症患者预后方面的疗效。
To determine the incidence of oesophageal carcinoma in patients with achalasia and to establish the efficacy of endoscopic surveillance, 195 consecutive patients with achalasia (90 men and 105 women, mean age 52 years), who were treated by pneumatic dilatation in our institution between 1973 and 1988 were prospectively studied. None of the patients had undergone cardiomyotomy. Follow up totalled 874 person years after pneumatic dilatation. In this period three patients developed an oesophageal squamous cell carcinoma. The mean age at diagnosis of the oesophageal carcinoma was 68 years (37, 77, and 89 years). The mean period between the onset of dysphagia and the diagnosis of the tumour was 17 years (19, 28, and 5 years); the mean interval between the diagnosis of achalasia and carcinoma was 5.7 years (5, 8, and 4 years). The incidence of oesophageal squamous cell carcinoma in this series (3.4/1000 patients per year) is significantly higher than the statistically expected incidence (0.104/1000 patients per year) using age and sex specific incidence data from the population of the Netherlands (Poisson statistics: p < 0.001). The risk of developing oesophageal squamous cell carcinoma in patients with achalasia is therefore increased 33 fold. Periodic endoscopy showed the potential for detecting early stage oesophageal carcinoma in two cases but a larger study with a longer follow up is required to determine the efficacy of endoscopic screening in improving the prognosis for patients with achalasia who develop oesophageal squamous cell carcinoma.