十二指肠球部胃黏膜异位的临床观察

Clinical analysis of heterotopic gastric mucosa in duodenal bulb

目的观察十二指肠球部胃黏膜异位(heterotopic gastric mucosa in the duodenal bulb,HGMDB)的临床特点,探讨其治疗方法。方法分析、总结经内镜、病理检查等确诊为十二指肠球部胃黏膜异位患者的临床资料、内镜报告、病理报告等。结果共14例患者。男7例,女7例;年龄26～73岁,平均48岁。病程1个月～10余年,患者均以反复上腹部疼痛为首发症状。胃镜下观察所有患者的幽门和十二指肠球部无变形,黏膜未见糜烂、溃疡;球部病变多位于前壁;分别呈扁平斑片状或鹅卵石样隆起、息肉样隆起、菜花样隆起等,表面光滑,色泽偏红、偏白或与附近球部黏膜相仿;靛胭脂染色腺管开口与十二指肠球部黏膜相似。病理检查与十二指肠球部黏膜固有层均可见胃底腺,有典型的含强嗜酸性颗粒的壁细胞和含嗜碱性颗粒的主细胞。使用H2受体拮抗剂(H2RA)或质子泵抑制剂(PPI)治疗可缓解症状;2例患者接受内镜下高频电烧灼术,1例症状明显改善,1例无效。结论HGMDB以中年发病多,性别无差异,常以上腹部疼痛为首发症状;胃镜检查的普及、内镜技术水平的提高及与其他铺助检查手段的联合应用有助于HGMDB的检出;H2RA和PPI等可有效缓解症状,内镜下高频电烧灼术等可能有助于HGMDB的治疗。

[Objective] To observe the clinical features of heterotopic gastric mucosa in duodenal bulb （HGMDB）, and to discuss therapies of HGMDB. [Methods] Cases of HGMDB diagnosed by endoscopy were analyzed. [Results] Fourteen patients were observed, 7 males and 7 females, and the their age ranged from 26 to 73 years （mean, 48）. Disease histories of all patients were from one month to more than ten years. All patients suffered epigastric pain and this was the first symptom. Most of these patches were located in the anterior wall of the duodenal bulb, and these patches had different forms. Biopsies of these patches showed fundic type gastric mucosa with chief and parietal cells. The use of H2 receptor antagonist （H2RA） or proton pump inhibitors （PPI） could relieve the symptoms of the disease. High frequency electricity heat probe was used to bum off the heterotopic gastric mucosa tissues in the duodenal bulb via endoscope. One patient＇s symptom was relieved apparently, while others had no effect. [Conclusions] HGMDB were mostly found in middle-ager, and they had no difference between male and female. Epigastric pain was the first symptom. The popular uses of gastroscopy and other auxiliary examination methods raised the detection rate of HGMDB. H2RA or PPI could relieve the symptoms. High frequency electricity bumoff maybe a useful method for the treatment of HGMDB.