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目的分析和总结特殊病因引起的胃巨大溃疡的临床特点,为正确诊治这类疾病积累经验。方法对本院1976年1月至2000年12月间发现的4986例患者的胃巨大溃疡进行回顾性分析。对其中59例具有特殊病因的胃巨大溃疡病例,分析和总结其内镜形态、病理组织学、诊断方法、治疗和预后特点。结果59例中包括胃嗜酸性肉芽肿32例,胃类癌8例,胃血吸虫病8例,胃克罗恩病5例,胃淋巴瘤4例,胃型Behcet病2例。其中10例胃嗜酸性肉芽肿,3例胃类癌,3例胃血吸虫病,5例胃克罗恩病,3例胃淋巴瘤,1例胃Behcet病首次胃镜活检误诊为BorrmannⅡ型胃癌。结论特殊病因的胃巨大溃疡根据发病机制可分为3类:①胃非上皮来源肿瘤;②胃肉芽肿性病变;③胃血管病变。溃疡形态、病史、体检和实验室检查对明确病因有一定帮助。常规胃镜黏膜组织活检可能造成部分病例误诊。应根据病因采用适当辅助检查评估病情并制订综合治疗方案。
Objective To analyze and summarize the clinical features of gastric ulcer caused by special etiology and gain experience for the correct diagnosis and treatment of such diseases. Methods The gastric ulcer in 4986 patients discovered from January 1976 to December 2000 in our hospital was retrospectively analyzed. Fifty-nine cases of gastric ulcer with special etiology were analyzed and summarized. The endoscopic features, histopathology, diagnosis, treatment and prognosis were analyzed and summarized. Results 59 cases included 32 cases of gastric eosinophilic granuloma, 8 cases of stomach cancer, 8 cases of stomach schistosomiasis, 5 cases of gastric Crohn’s disease, 4 cases of gastric lymphoma and 2 cases of gastric Behcet’s disease. Among them, 10 cases of gastric eosinophilic granuloma, 3 cases of stomach cancer, 3 cases of stomach schistosomiasis, 5 cases of gastric Crohn’s disease, 3 cases of gastric lymphoma, and 1 case of gastric Behcet’s disease were misdiagnosed as Borrmann type II gastric cancer. Conclusion The special etiology of gastric ulcer according to the pathogenesis can be divided into three categories: ① gastric non-epithelial tumors; ② gastric granulomatous lesions; ③ gastric vascular lesions. Ulcer morphology, medical history, physical examination and laboratory tests have a definite cause of help. Conventional endoscopy mucosal biopsy may cause some cases misdiagnosis. Should be based on the cause of the use of appropriate auxiliary examination to assess the condition and develop a comprehensive treatment plan.