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消化道疾病诊断病理学
$36.03
本书以内镜活检材料为基础,以消化道的常见病和多发病为重点,描述了疾病的病变特点、病变分类和诊断标准,讨论了有关的病因和发病机制,配有相应的彩图200余幅。本书可供病理科和消化科医务人员使用,亦可供有关研究生学习。
章 食管节 正常解剖组织形态一、黏膜二、黏膜下层三、肌层四、外膜第二节 巴雷特食管一、巴雷特上皮的发生来源二、巴雷特上皮形态三、巴雷特食管的合并症第三节 食管炎一、反流性食管炎二、细菌性食管炎三、巨细胞病毒性食管炎四、疱疹病毒性食管炎五、假丝酵母茵性食管炎六、腐蚀性食管炎七、药物性食管炎八、化疗及放疗引起的食管炎九、器官移植第四节 食管息肉一、炎性息肉二、乳头状瘤性息肉三、纤维血管性息肉四、炎性纤维样息肉第五节 食管良性肿瘤一、乳头状瘤二、腺瘤三、平滑肌瘤四、颗粒细胞瘤第六节 食管恶性肿瘤一、食管的癌前状态及癌前病变二、鳞状细胞癌三、基底细胞样鳞状细胞癌四、淋巴上皮瘤样癌五、腺癌六、腺样囊性癌七、小细胞癌八、、癌肉瘤九、平滑肌肉瘤十、胃肠基质瘤十一、类癌第二章 胃第三章 十二指肠第四章 小肠第五章 阑尾疾病第六章 大肠疾病第七章 肛管疾病
章 食管 节 正常解剖组织形态食管全长约25cm,男性平均长25.3cm,女性平均长23.6cm。胃镜检查时,从中切齿测量,全长约40cm。食管有三处狭窄:上狭窄:在食管起始,相当于环状软骨下缘平面,平第5~6颈椎,口径约l.5cm。此狭窄距中切齿约15cm。中狭窄:与左主支气管右方相交处,平第4~5胸椎,距中切齿约25cm。下狭窄:在食管穿过食管裂孔处,平第10胸椎,距中切齿约40cm。在胃镜观察时,为了便于描述病变的部位,将食管分为上、中、下三段,从中切齿测量,上段在23cm以上,中段23~32cm,下段32~40cm。 食管与胃之间的压力差大,以防止胃内食物反流人食管,食管末端有生理性括约肌,位于食管裂孔上、下2~3cm范围,该处肌层并未增厚,但在神经、体液因素的作用下,肌张力增强,内腔压力明显增高,可达胃底压的8倍。正常人食管末端压力约2 kPa,而胃内压仅为0.67~1.34 kPa,这样就有效地防止了反流。食管内压大于4 kPa时,易发生失弛缓,小于0.97kPa时易出现反流。当饱食后和强力咳嗽时,胃内压升高,要发生反流,这是生理性反流,每天都可发生,反流的酸性物质(有时还有胆汁)可损伤食管黏膜。正常人约每分钟要吞唾液一次,唾液一方面可中和胃酸和胃蛋白酶,另一方面它与食管黏膜分泌的黏液混合,保护了食管黏膜。食管裂孔在食管下端、主动脉裂孔的左前方,平第10胸椎,其中有食管及迷走神经通过。 ……
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