术后反流性胃炎与慢性胃炎的病理组织学对照研究

Histopathology of postgastrectomy reflux gastritis and chronic gastritis: A comparative study

目的探讨术后反流性胃炎的病理组织学变化特征及病理学诊断标准。方法溃疡胃大部切除术后患者５０例，慢性胃炎患者４０例，行胃镜检查，分别在吻合口／胃窦、胃体、胃底取活检，作病理组织学检查。观察各种病变的严重程度，计算反流积分与炎症积分；比较不同部位病理改变的特点；分析胆汁反流、ｐＨ与病理改变的关系。结果残胃的胆汁酸浓度和ｐＨ显著高于慢性胃炎组（Ｐ＜０．０１），粘膜基底层胃小凹增生、间质水肿、毛细血管扩张充血及反流积分，在残胃组显著高于慢性胃炎组（Ｐ＜０．０１），且以吻合口最重。而残胃底较轻。残胃内不同部位的病变特征不同。结论胃小凹增生、间质水肿、毛细血管扩张充血是反流性胃炎的主要病理组织学特征，反流积分的高低可代表反流性病变的严重程度。

Objective To determine the characteristics of postgastrectomy reflux gastritis and its pathological diagnostic method.Methods Biopsy specimens were taken from anastomotic stoma / antrum, gastric body, gastric fundus in 50 patients who had been treated by gastrectomy for peptic ulcer and in 40 patients with an intact stomach who had chronic gastritis. The specimens were studied using semi- quantitative histological method. The histopathological changes were observed, and the relationship between histopathological changes and bile reflux were analysed.Results The concentration of bile acid and pH in the fasting gastric juice were higher in the residual gastric stump than that in the intact stomach (P< 0. 01). The degree of foveolar hyperplasia, interstitial edema, capillarectasia and congestion of the lamina propria mucosae, and reflux gastritis score were higher in the gastric stump than that in the intact stomach (P< 0.01 ), with the highest at anastomosis. The pathological characteristics were difference in different parts of the residual stomach.Conclusion Postgastrectomy reflux gastritis is characterized by foveolar hyperplasia, edema, vasodilation and congestion of the lamina propria, and the seventy of reflux gastritis can be represented sensitively by reflux gastric score.