胃嗜酸性肉芽肿的诊断与治疗

Diagnosis and treatment of gastric eosinophilic granuloma (GEG)

目的 提高胃嗜酸性肉芽肿的诊治水平及疗效。方法 回顾性分析 1988年 8月～1998年 10月我院收治经手术病理证实的胃嗜酸性肉芽肿病人 2 0例 ,并进行随访。结果 5例行部分胃切除 ,8例行大部胃切除 ,3例行次全胃切除 ,4例行根治性胃切除术 ,手术无并发症及死亡。随访经X线钡餐或纤维胃镜复查 18例 (90 % ) ,其中 7～ 9年 10例 ,4～ 6年 6例 ,1～ 3年 2例 ,均无复发 ,且未见癌变。结论 仔细询问病史 ,X线钡餐、纤维胃镜及外周血嗜酸性粒细胞计数是明确胃嗜酸性肉芽肿的重要依据。其中纤维胃镜必须在溃疡边缘作挖掘式活检深达胃粘膜下组织病理检查 ,可提高术前诊断率。手术切除是最有效的治疗方法。

Objective To investigate the diagnosis and therapy of GEG and improve its treatment. Methods We summarized and analyzed the treatment methods of the 20 patients of GEG which had been proved by pathology in our hospital from Aug.1988 to Oct.1998, and most patients were follow-up.Results Partial gastrectomy was performed in 5 patients, subtotal gastrectomy in 8 , total gastrectomy in 3, radical gastrectomy in 4 . No complication and death occurred in this cases. 18 patients (90%) had been checked either by X rays and GI or by gastrofiberscope during follow-up period, of which, 10 patients had been observed for 7 to 9 years,6 for 4 to 6 years,2 for 1 to 3 years, and there were neither relapses nor cancerous changes .Conclusions GEG is a comparatively less common disease, but the rate of its misdiagnosis and mistreatment is high. The author consider that a clear diagnosis of the disease rely on detailed case history, X rays and GI,gastrofiberscope and peripheral blood eosinophilic granulocyte counting.Excavative biopsy around the ulcer should be performed in order to get the tissue under the mucous and to make correct diagnosis before operation. Operative resection is the most effective method.