探究贲门失弛缓症(AC)合并食管肿瘤性病变的严重程度与病变部位、既往AC治疗史等临床因素的关联，为AC患者癌变风险分层及内镜随访策略提供临床依据。

单中心回顾性纳入2014年1月至2023年12月经解放军总医院消化内科医学部住院确诊AC合并食管肿瘤性病变患者。依据病变检出前是否接受AC治疗分为既往AC治疗组和无既往AC治疗组；将食管病变分为低级别病变(低级别上皮内瘤变LGIN)、高级别/浸润性病变(高级别上皮内瘤变HGIN/Tis＋浸润性食管癌)。采用Fisher确切检验分析分类变量分布差异，计量资料依分布选用独立样本t检验或Mann-Whitney U检验，双侧P<0.05为探索性差异有统计学意义。

最终纳入18例患者，其中LGIN 5例、HGIN/Tis 2例、浸润性食管癌11例；9例存在AC治疗史(既往AC治疗组)、9例无AC治疗史(无既往AC治疗组)。既往AC治疗组病灶以食管下段为主(77.8%)，5例LGIN、4例HGIN/Tis或浸润癌；无既往AC治疗组病灶多位于食管中段(66.7%)，全部为HGIN/Tis或浸润性食管癌，食管扩张发生率为88.9%。组间分布差异：病变部位Fisher P＝0.036，既往AC治疗史Fisher P＝0.029，食管扩张Fisher P＝0.099；吞咽困难病程与病变严重程度无明显分布差异。

AC合并食管肿瘤性病变的病变严重程度与病变位置、既往AC治疗史存在探索性分布差异；食管下段病变、有AC干预史者多为LGIN，食管中段、未接受AC治疗者更易出现HGIN/Tis。临床应对长期AC、食管中段黏膜异常、高龄、男性、饮酒人群建立长期内镜监测机制。

To explore the associations between lesion severity and lesion location, prior treatment history of achalasia (AC) in patients with AC combined with esophageal neoplastic lesions, and provide evidence for risk stratification and endoscopic surveillance of AC patients.

A single-center retrospective study enrolled patients diagnosed with AC combined with esophageal neoplastic lesions hospitalized in Chinese PLA General Hospital from January 2014 to December 2023.Patients were divided into prior AC treatment group and non-prior AC treatment group based on whether AC intervention was performed before lesion detection.Esophageal lesions were dichotomized into low-grade lesions (low-grade intraepithelial neoplasia, LGIN) and high-grade/invasive lesions(high-grade intraepithelial neoplasia HGIN/Tis+ invasive esophageal cancer).Fisher′s exact test was used to compare categorical variables; independent sampletest or Mann-Whitney U test was adopted for measurement data according to data distribution.Two-sided P<0.05 indicated exploratory statistically significant difference.

A total of 18 eligible patients were enrolled, including 5 cases of LGIN, 2 cases of HGIN/Tis, and 11 cases of invasive esophageal cancer. Nine patients had received AC intervention (prior AC treatment group), and 9 had no AC treatment history (non-prior AC treatment group).Lesions in prior AC treatment group were predominantly located in the lower esophagus (77.8%), including 5 LGIN and 4 HGIN/Tis or invasive cancer.Lesions in non-prior AC treatment group mostly occurred in the middle esophagus (66.7%), all presented as HGIN/Tis or invasive esophageal cancer with an esophageal dilatation rate of 88.9%.Distribution differences between groups: lesion location Fisher P=0.036, prior AC treatment Fisher P=0.029, esophageal dilatation Fisher P=0.099.No obvious distribution difference was observed between dysphagia duration and lesion severity.

Exploratory distribution differences exist between lesion severity and lesion location, prior AC treatment history in AC patients with esophageal neoplastic lesions. Lesions in lower esophagus or patients with AC intervention history are mostly low-grade intraepithelial neoplasia, while patients with middle esophageal lesions and without AC treatment are prone to high-grade and invasive lesions.Long-term endoscopic surveillance is recommended for AC patients with long disease duration, middle esophageal mucosal abnormalities, advanced age, male gender and alcohol drinking history.