CAJ | 학술논문

目的：探讨中国患者与加拿大患者在相似的胃食管反流情况下行食管切除胃食管吻合术后残余食管黏膜损伤的差异。方法前瞻性纳入2010年9月至2013年10月分别于加拿大蒙特利尔大学医学中心及四川大学华西医院行食管切除胃代食管术后的加拿大高加索人群及中国汉族人群，并按照完全相同的手术方式进行1∶1配对研究。比较两组患者术后反流情况，评估两组内镜下食管黏膜损伤程度（MUSE分级标准），并进行病理检测及食管上皮细胞增生指数检测。结果共纳入食管切除术后的加拿大及中国患者各18例，术后随访时间为45（28～67）月。两组患者术后明显反流症状出现率及评分、反流性食管炎的发生率以及内镜下所见的黏膜糜烂、溃疡及狭窄的发生率间比较，差异均无统计学意义（均P＞0．05）。而加拿大患者黏膜化生发生率[44．4％（8／18）比11．1％（2／18），P＝0．026]，MUSE食管黏膜损伤评分[1．5（1．0～2．0）比1．0（0～2．0），P＝0．042]及食管上皮细胞增生指数[0．40（0．30～0．45）比0．35（0．30～0．50），P＝0．038]均明显高于中国患者。结论在相似的胃食管反流情况下，加拿大患者的食管黏膜对胃食管反流的不良刺激较中国患者更为敏感，食管黏膜损伤更为严重。
목적：탐토중국환자여가나대환자재상사적위식관반류정황하행식관절제위식관문합술후잔여식관점막손상적차이。방법전첨성납입2010년9월지2013년10월분별우가나대몽특리이대학의학중심급사천대학화서의원행식관절제위대식관술후적가나대고가색인군급중국한족인군，병안조완전상동적수술방식진행1∶1배대연구。비교량조환자술후반류정황，평고량조내경하식관점막손상정도（MUSE분급표준），병진행병리검측급식관상피세포증생지수검측。결과공납입식관절제술후적가나대급중국환자각18례，술후수방시간위45（28～67）월。량조환자술후명현반류증상출현솔급평분、반류성식관염적발생솔이급내경하소견적점막미란、궤양급협착적발생솔간비교，차이균무통계학의의（균P＞0．05）。이가나대환자점막화생발생솔[44．4％（8／18）비11．1％（2／18），P＝0．026]，MUSE식관점막손상평분[1．5（1．0～2．0）비1．0（0～2．0），P＝0．042]급식관상피세포증생지수[0．40（0．30～0．45）비0．35（0．30～0．50），P＝0．038]균명현고우중국환자。결론재상사적위식관반류정황하，가나대환자적식관점막대위식관반류적불량자격교중국환자경위민감，식관점막손상경위엄중。
Objective To compare the difference of mucosal damage in the remnant esophagus with similar postoperative reflux after esophagectomy and gastric interposition between Chinese and Canadian population. Methods A prospective 1∶1 paired study based on the same surgical approach was performed in Medical Centre of University of Montreal and West China Hospital of Sichuan University during the period from September 2010 to October 2013. The patients were followed up and evaluated by reflux symptom scoring, endoscopic assessment of mucosal damage, pathologic examination of biopsies and proliferation index test of esophageal epithelium. Results Eighteen Han Chinese and 18 Caucasian Canadian patients with esophagectomy and gastric interposition were included in this study , with a follow-up period of 45 (28-67) months. There were no significant differences between the two groups in the incidence of postoperative reflux symptom, reflux symptom scoring, histological reflux esophagitis, erosion or stricture of remnant esophagus (all P>0.05). However, the incidence of mucosal metaplasia [44.4%(8/18) versus 11.1%(2/18), P=0.026], quantitative MUSE scoring [1.5(1.0-2.0) versus 1.0 (0-2.0), P=0.042] and proliferation index [0.40 (0.30-0.45) versus 0.35 (0.30-0.50), P=0.038] of esophageal epithelium were significantly higher in Canadian patients than those in Chinese patients. Conclusion Under similar reflux situation, esophageal mucosa of Canadian population is more sensitive to the gastroesophageal reflux damage compared with Chinese population , resulting in more severe reflux damage of remnant esophagus in Canadian patients.