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目的:通过动物实验探讨胃及十二指肠内容物反流导致食管的形态学变化及其在反流性食管炎(RE)发病中的作用。方法:运用不同手术方式制作单纯胃食管反流(G组)、单纯十二指肠食管反流(D组)及十二指肠胃混合食管反流(DG组)动物模型。于不同病程分批取得食管标本进行大体、光镜及电镜研究。结果:大体及光镜下见各实验组出现程度不等的食管炎症、糜烂、溃疡、上皮高度增生,D组病变最重、发病率最高,DG组次之,G组最轻。电镜下见G组表层细胞脱落,细胞间隙增宽,桥粒减少;D组损害较严重,细胞表面微褶明显减少、不规则,细胞膜不连续,细胞器变性;DG组兼见以上两种改变。结论:胃及十二指肠反流均可造成明显食管粘膜损伤,但不同的反流物引起的上皮病变表现及程度均有差别,在RE发生中均有重要意义。
OBJECTIVE: To investigate the morphological changes of the esophagus and its role in the pathogenesis of reflux esophagitis (RE) through animal experiments on reflux of gastric and duodenal contents. Methods: Animal models of simple gastroesophageal reflux (G group), simple duodenal esophageal reflux (Group D) and duodenogastric gastroesophageal reflux (DG group) were made by different surgical methods. Esophageal specimens were obtained in different stages of the disease in general, light microscopy and electron microscopy. Results: In the general and light microscope, we found esophageal inflammation, erosion, ulcer and epithelial hyperplasia in each experimental group with the highest incidence of disease in group D, followed by DG group and the lightest in group G. Under the electron microscope, the cells in the G group were shedding, the cell gap widened and the desmosome size was reduced. In the D group, the damage was more severe, and the micro-folds on the cell surface were obviously reduced, irregular, the cell membrane was discontinuous and the organelles were degenerated. CONCLUSIONS: Gastric and duodenal reflux can cause significant esophageal mucosal injury, but the performance and extent of epithelial lesions caused by different reflux are different, which are of great significance in the occurrence of RE.