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目的：探讨食管粘膜活检取样误差的发生机制及对策。方法：对来自河南食管癌高发区２８例患者行食管内镜检查和中、下段粘膜活检组织病理检查，１０天短期随访后对同一人群作重复检查；并对８８位无症状受检者进行碘染与活检相结合的方法。结果：第二次粘膜活检组织中，食管中段２４％的患者病变减轻，２８％的患者病变加重，４８％的患者病变维持不变。食管下段粘膜活检中，４８％的患者病变减轻，１６％的患者病变加重，３２％的患者病变维持不变；碘染受检者的食管粘膜中染色正常和染色异常的粘膜组织在癌前病变各阶段的构成比无明显差异。组织形态学测量显示：各级癌前组织与正常上皮组织的厚度无明显差异。结论：粘膜活检取样误差可严重影响组织病理学检查随访结果。食管粘膜癌前病变，特别是较轻度病变的厚度与同期正常上皮无明显改变，造成内镜下识别困难，是造成取样误差的重要因素。碘染可明显提高内镜下病变与同期正常组织的识别，但对小范围病变的活检准确度仍需改进。肿瘤抑制基因ｐ５３蛋白聚集的重复性检出率较高，可能是食管癌变过程中的有效指标。
Objective: To explore the mechanism of esophageal mucosal biopsy sampling errors and its countermeasures. Methods: Esophageal endoscopy and mucosal biopsy were performed in 28 patients with high incidence of esophageal cancer in Henan province. The same group of people were repeatedly examined after 10 days of short-term follow-up. 88 asymptomatic subjects were subjected to iodine Dye and biopsy combined method. Results: In the second mucosal biopsy, the lesions in 24% of the middle esophagus lessened, the lesions in 28% increased, and the lesions in 48% unchanged. In the lower esophageal mucosal biopsy, lesions of 48% were lessened, lesions of 16% were aggravated, lesions of 32% were unchanged, mucosal tissues with normal staining and abnormal staining in esophageal mucosa of Iodine staining were significantly different from those in precancerous lesions The composition ratio of each stage is no significant difference. Histomorphometry showed no significant difference in the thickness of precancerous tissue and normal epithelium at all levels. Conclusion: Mucosal biopsy sampling errors can seriously affect the follow-up results of histopathological examination. Esophageal mucosal precancerous lesions, especially mild lesions with the same period of normal epithelial thickness did not change significantly, resulting in identification difficult endoscopic, sampling error is caused by an important factor. Iodine staining can significantly improve the endoscopic lesions and the identification of normal tissue, but the accuracy of biopsy of small lesions still need improvement. Tumor suppressor gene p53 protein aggregation of the repetitive detection rate may be an effective indicator of esophageal carcinogenesis.