77例植物性胃石症患者的内镜表现及临床特点研究

Characteristics of clinical and endoscopic findings of phytobezoars:analysis of 77 cases

目的探讨胃石症患者的内镜下表现及临床特点,提高诊断准确率,避免严重并发症的发生。方法回顾性分析2015年1月至2020年12月我院消化内科经内镜及临床资料确诊为植物性胃石症的77例患者。结果54例患者在内镜检查时被发现伴有溃疡,占胃石症患者总例数的70.1%。溃疡好发部位以胃角最多见,其次为胃窦、十二指肠和胃底体;单发溃疡者比多发溃疡者多见。内镜下溃疡长径<2 cm者多于≥2 cm者,溃疡内镜下表现多种多样,大部分类似良性溃疡表现,溃疡基底及周边黏膜覆血痂或出血点者多见。≥60岁的老年患者合并溃疡出血、胃肠道梗阻等并发症发生率高于<60岁的胃石症患者。结论即使内镜下无明确胃石发现,对不明原因胃肠道梗阻和溃疡的病因诊断也应警惕胃石症可能,尤其对伴有胃部手术史等高危因素的患者而言。老年胃石症患者更易合并出血及胃肠道梗阻等并发症。

Objective To investigate the endoscopic and clinical characteristics of phytobezoars,improve diagnostic accuracy and avoid the serious complications.Methods We retrospectively reviewed data of 77 patients with phytobezoars admitted to our hospital from Jan.2015 to Dec.2020.Cases were diagnosed by clinical presentation and endoscopic examination.Results 54 patients were found with ulcer during endoscopy,accounting for 70.1% of the total number of patients with phytobezoars.The most common site of ulcer was gastric angle,followed by gastric antrum,duodenum,gastric body and fundus.Single ulcer was more common than multiple ulcers.Endoscopic examination showed that ulcers with length and diameter less than 2 cm were more common.The endoscopic manifestations of ulcers were various,most of them were similar to benign ulcers,and the ulcer base and surrounding mucosa were often covered with blood scabs or bleeding points.The incidence of complications such as ulcer bleeding and gastrointestinal obstruction in elderly patients over 60 years old was higher than that in patients with phytobezoars under 60 years old.Conclusion Even if there is no clear discovery of bezoars under endoscopy,we should be alert to the possibility of bezoars in the etiological diagnosis of unexplained gastrointestinal obstruction and ulcer,especially for patients with high-risk factors such as history of gastric surgery.Complications such as gastrointestinal obstruction and bleeding are more likely to occur in elderly patients with bezoars.