十二指肠球部胃黏膜异位230例临床病理分析

The clinical and pathological characteristics of heterotopic gastric mucosa in duodenal bulb

目的探讨十二指肠球部胃黏膜异位的临床、内镜、病理特征及诊断。方法 回顾性分析230例十二指肠球部胃黏膜异位的临床病理资料,分析其临床、内镜、病理特点及诊断方法。结果 十二指肠球部胃黏膜异位的发生率为0.59%;男性144例,女性86例;平均发病年龄(65.34±10.36)岁;其中179例患者伴有反复的上腹部不适;所有病例都伴有炎症和(或)其他消化道疾病;十二指肠球部胃黏膜异位分为两型:Ⅰ型由胃型腺体和胃小凹上皮组成,Ⅱ型直接由胃小凹上皮组成,其中Ⅱ型与幽门螺杆菌感染有关;十二指肠胃黏膜异位内镜下表现有黏膜粗糙糜烂、片状黏膜结节状增生伴浅溃疡形成、广基息肉样增生、扁平增生等,且内镜下并无直接诊断胃黏膜异位者。结论 十二指肠处胃黏膜异位的发生以男性居多,年龄分布以中老年为主,与十二指肠炎、糜烂等炎性疾病有关;Ⅰ型胃黏膜异位可能与先天异常有关,Ⅱ型胃黏膜异位可能与胃小凹上皮的化生有关;内镜下可见十二指肠处黏膜粗糙、糜烂、结节状增生,尤其是息肉样增生需考虑胃黏膜异位的可能性。

Purpose To investigate the clinical, endoscopic, pathological features, occurrence and diagnosis of heterotopic gastric mucosa in duodenal bulb. Methods The clinical and pathological data of 230 cases of heterotopic gastric mucosa of duodenal bulb were retrospectively analyzed. The clinical, endoscopic, pathological features and diagnostic methods were analyzed. Results The prevalence of heterotopic gastric mucosa of duodenal bulb was 0.59%, including 144 males and 86 females. The mean age was 65.34±10.36 years, 179 cases of the heterotopic gastric mucosa duodenal bulb had recurrent upper abdominal discomfort, all of them had inflammation and/or other digestive tract diseases. Heterotopic gastric mucosa of duodenal bulb was divided into two types: type I consisted of gastric gland and foveolar epithelium, and type Ⅱ was composed only of foveolar epithelium. Type Ⅱ was related to Helicobacter pylori infection. Endoscopic images of heterotopic gastric mucosa of duodenal bulb showed rough erosion, mucosa nodular hyperplasia with superficial ulcer formation, broad-based polypoid hyperplasia, flat hyperplasia, and so on. There was no diagnosis of heterotopic gastric mucosa under endoscopy. Conclusion Heterotopic gastric mucosa duodenal bulb is more often present in men and middle age and old age patients, which is related to inflammatory diseases such as duodenitis and erosion. Type Ⅰ may be related to congenital abnormality, while type Ⅱ may be related to the gastric foveolar metaplasia. When endoscopists observe the rough mucosa, erosion, nodular hyperplasia, especially polypoid hyperplasia of duodenum, it is necessary to consider the possibility of heterotopic gastric mucosa.