| Esophageal carcinoma (EC)is one of the most common alimentary system carcinoma in our country,it onsets insidiously and there is no symptom or only slight symptom, and the patients who go to see the doctor are mostly advanced patients if progressive dysphagia appears.At present,the combination of endoscopy and histological examination has become a good method to diagnose precancerous lesion and earlier esophageal carcinoma.Electronic gastroscope has a high defining power,and the handling is better, the membrana mucosa can be observed at different angle in the stomach. The accurate rate of electronic gastroscopy with biopsy diagnosing the gastrointestinal diseases is more than 90%. Examining the doubtful esophageal carcinoma by applying electronic gastroscopy in combination with pathological tissue inspection, not only can improve the diagnosis rate of esophageal carcinoma,but also can identify whether there exist such comlications like esophago-tracheal fistula etc,it is of great importance to the therapy of patients.Combining with mucous membrane dyeing,it can also discover earlier esophageal carcinoma, which is of great value to enhance the curative ratio and survival rate.In this text,in order to approach relationship of the appearance at endoscope and the pathohistological features and enhance the biopsy masculine rate and the diagnosis rate of earlier esophageal carcinoma, we choosed 291 patients who had been diagnosed esophageal carcinoma by endoscope in the second clinic hospital of JilinUniversity from november 2000 to november 2005, analysing with their clinical data, noting their clinic symptom,age distribution,cancer predilection site,cancer pathohistology typing,and morphology character under gastroscope separately.Among this group of 291 cases of EC, disphagia and ingest pain are the main symptoms accounting about 81.79% and 61.51% separately, meanwhile accompanying epigastric distention,indisposition,belching,sour regurgitation,melena and macies, which is the same with what had been reported. The shortest of course is six day ,the longest is two year and the majority is three to six months. The ratio of male to female is 7.08:1 , the prevalence rate of male is higher than female and the risk of esophageal carcinogenesis increases with the age, the author thinks such bad habit like smoking,drinking and others contributing to the high incidence of EC in male than that of female. Among 291 cases,there are totally 7 cases multisource cancer(16 cancerous focuses ).Of the total, there are five cases two-region cancer (four cases esophageal two-region cancer and one case esphageal-gestro two-region caner)and two cases three-region cancer(one case esophageal trisource cancer and one case sinus piriformis- esophagus-cardia three- region cancer). Multisource cancer at endoscope shows: various kinds of tumor exist isolately , the mucous membrane among the focus of injection is smooth and good, lesion does not continue with each other.Among the total of 284 cases monosource cancer,the EC incidence rate of the superior segment, midpiece and inferior segment is 9.15%,61.97% and28.87% respectively. The poorly differentiated squamous carcinoma(SC) and moderately differentiated SC are the majority, the moderately differentiated SC holding 42.00% and the poorly differentiated SC holding 29.67%, the well differentiated SC 10.67%, signet-ring cell carcinoma 2.67%, anaplastic carcinoma 0.67% and AC 14.33%.There exists significant difference between SC and AC incidence in the midpiece and the superior segment (P < 0.01 ) , but there is no significant difference between SC and AC incidence in the inferior segment(P>0.05). The results above indicates that SC is the most common in the superior segment and middle piece,but the AC incidence in the inferior segment is higher than that of the superior and middle piece segment, and there is no significant difference between the two. Among 40 cases monosource esophageal carcinoma,2 cases occur in the superior segment,5 cases occur in the middle piece and 33 cases occur in the inferior segment,so it is obvious that the ACincidence from the superior segment to the inferior segment is higher and higher. Among 40 cases patient, 26 cases had once had the gastro-oesophageal reflux symptoms, like heartburn, sour regurgitation etc,15 cases (37.5%) had once been diagnosed Barrett esophagus(BE).In this group, more than 30.0% of BE patients developed ultimately into esophageal AC, which also verifies this succession that the gastro-esophageal reflux disease develops to BE , and develops to esophageal AC. Therefore, gastro-oesophageal disease and BE patients should be treated positively, the follow-up at the regular intervals is still significant.Esophageal endoscopic performance diversity,in this group, tumor infiltrating type is the most common among the middle-later EC at endoscope ,holding 61.00%,it is the same with what had been reported. There exists significant difference between SC and AC incidence in tumor infiltrating type,tumor type,ulcer infiltrating type and periphery sclerosing type(P<0.01);there exists no significant difference between SC and AC incidence in the ulcer type(P>0.01).Among 43 cases of esophageal AC ,the ulcer type at endoscope is the majority,holding 34.88%.It is indicated from above that SC incidence is higher than that of AC in tumor infiltrating type,tumor type,ulcer infiltrating type and periphery sclerosing type,and there exists significant difference between them ,which is the same with what had been reported.The AC incidence in the ulcer type is higher than that of other types.Among the esophageal AC,the ulcer type is the majority,which is the same with what had been reported. It indicates that there exists the relationship between the appearance at endoscope and the pathohistological features of EC.The first time biopsy masculine rate in this group is 91.4%, which is close to what had been reported,other cases is negative, so the patients have to bear repeated endoscopy and cytologic examination by esophageal abrasive balloon,which adding pain to the patients and delaying the diagnosis time and best cure opportunity. The author thinks we should emphasize the first lot when taking biopsy, try to take the neoplasm and the edge of ulcer, by which can we raise the biopsy masculine rate.If the endoscope unable to pass,combining X-ray barium meal examination can help us to know the length of lesion, find the complications and multisource carcinoma,which is of great importance to the therapy. We diagnosed 7 cases of multisource carcinoma,holding 2.40%,which is the same with what had been reported. Nine cases of earlier EC were diagnosed in this group, three cases is negative in the first biopsy.But the three werefinally diagnosed early EC by biopsy after dyeing the mucosa,which enhances the diagnosis rate up to 33.3%.Conclusion:the appearance of EC at endoscope is various, observing the esophagus mucosa at euthyphoria endoscope to take biopsy is an effective method to diagnose EC.Mucosa pigment dyeing can reveal the extent of disease clearly and it strengthens the contrast between the affection and normal mucosa, which is of great importance to the diagnosis rate of the earlier EC.The predilection site of tumor is: the midpiece> the inferior segment>the superior segment,SC incidence is common in the superior segment and themidpiece,AC incidence of the inferior is high than that of theother two sites.The incidence of SC is higher than that of AC intumor infiltrating type,tumor type,ulcer infiltrating type andperiphery sclerosing type,while the ulcer type is the most commonin AC,which indicates that there exists the relationship betweenthe appearance at endoscope and the pathohistologicalcharacteristics of EC.
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