成人小肠胃黏膜异位致消化道出血11例

Adult intestinal heterotopic gastric mucosa resulting in alimentary tract hemorrhage:a report of 11 cases

目的探讨小肠胃黏膜异位并发消化道出血的临床诊断与治疗。方法对我院24年间收治的11例小肠胃黏膜异位并发消化道出血的病例资料进行回顾性分析。结果11例患者发病中位年龄29岁。其中9例发病有腹痛。常规内镜检查均无阳性发现；6例于手术前行放射性^(99m)锝核扫描均有放射性示踪剂吸收和浓集；1例肠系膜钡餐示末段回肠重复畸形；1例选择性肠系膜血管造影发现近端空肠出血。本组病例均行病变部位小肠段切除,术后病理报告均为胃黏膜异位症,其中病变位于空肠者5例,回肠者6例。11例病灶与肠憩室、肠壁炎性肿块、肠重复畸形并存。11例术后均痊愈出院。结论放射性^(99m)锝扫描对小肠胃黏膜异位症术前诊断有重要意义；手术治疗有效。

Objective To investigate the clinical characteristics, diagnosis and treatment of intestinal heterotopic gastric mucosa resulting in alimentary tract hemorrhage. Methods Eleven cases of intestinal heterotopic gastric mucosa with alimentary tract hemorrhage during the past 24 years in our hospital were reviewed and the clinical data were analyzed retrospectively. Results The median age was 29 years old. Nine cases had abdominal pain, and radionuclide ^99mTc-pertechnetate scan revealed bleeding lesion in 6 cases preoperatively. Segmental resection of the intestine with bleeding lesion were performed in all patients, postoperative pathology confirmed heterotopic gastric mucosa. The lesion was located in the jejunum in five cases and in the ileum in six cases. All lesions were complicated with diverticulum, or inflammatory mass on the intestinal wall, or abnormity of intestinal duplication. Conclusions Intestinal heterotopic gastric mucosa is difficult to be diagnosed preoperatively, and radionuclide ^99mTc-pertechnetate scan plays a role in preoperative diagnosis.