胆囊切除术后胃十二指肠黏膜的内镜病理分析  

Endoscopic and pathologic features of gastric and duodenal mucosa after cholecystectomy

作　　者：常玉英[1] 黄永辉[2] 陈波[1] 谢静[1] 成仲琴 李晓琼[1] 

机构地区：[1]四川省第四人民医院消化内科,成都610016 [2]北京大学第三医院消化内科

出　　处：《西南国防医药》2011年第1期33-35,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探讨胆囊切除术后胃十二指肠黏膜的内镜和病理检查变化。方法对206例胆囊切除术后胆汁反流性胃炎患者行胃镜诊断,并进行活检病理检查,采用快速尿素酶法检测幽门螺旋杆菌。结果 206例中,胆汁反流合并反流性食管炎33例,Barrett食管15例,食管溃疡4例,胃溃疡25例,十二指肠溃疡50例,十二指肠炎56例,胃息肉10例,十二指肠息肉28例。内镜下表现为:充血水肿189例,糜烂106例,黏膜下出血88例,疣状糜烂67例,萎缩性胃炎35例,颗粒样增生48例,幽门功能不全45例(闭合不全弛缓),胃底体黏膜皱襞增粗38例,胆汁由幽门进入胃窦66例;内镜下胆汁反流分级:Ⅰ级88例,Ⅱ级69例,Ⅲ级49例;慢性炎症176例,急性炎症32例,活动性炎症77例,肠腺化生56例,上皮内瘤变39例,萎缩性炎症37例,淋巴细胞增生33例,炎性息肉10例。幽门螺旋杆菌阳性66例,占32%,低于同期非胆汁反流性胃炎的61.9%。结论胆囊切除术与胆汁反流有关,胆汁反流可以造成多种食管、胃、十二指肠黏膜疾病,内镜和病理检查是诊断胆汁反流性胃炎的较好手段。幽门螺旋杆菌感染与胆汁反流性胃炎没有明确的关系。Objective To investigate the endoscopic and pathologic changes of gastric and duodenal mucosa after cholecystectomy.Methods 206 patients having received cholecystectomy were diagnosed as bile reflux gastritis under gastroscope.Their biopsy specimens of gastric and duodenal mucosa were obtained for pathological examination.Rapid urease method was used to detect Helicobacter pylori in mucosal samples.Results Among 206 cases,there were 33 cases of reflux esophagitis,15 cases of Barrett esophagus,4 cases of esophageal ulcer,25 cases of gastric ulcer,50 cases of duodenal ulcer,56 cases of duodenitis,10 cases of gastric polyp,28 cases of duodenal polyp.Gastroscopy showed congestion and edema in 189 cases,erosion in 106 cases,submucosal bleeding in 88 cases,verrucosa erosion in 67 cases,atrophic gastritis in 35 cases,granular hyperplasia in 48 cases,pylorus disfunction in 45 cases,thickening mucosal fold of fundus gastricus and gastric body in 38 cases,and bile reflux into the stomach via pylorus in 66 cases.According to Kellosalo standards,206 cases with bile reflux were divided into grade Ⅰ in 88 cases,grade Ⅱ in 69 cases,grade Ⅲ in 49 cases.There were chronic inflammation in 176 cases,acute inflammation in 32 cases,active inflammation in 77 cases,intestinal metaplasia in 56 cases,intraepithelial neoplasia in 39 cases,chronic atrophic gastritis in 37 cases,lymphocyte proliferation in 33 cases and inflammatory polyp in 10 cases.66 cases of bile reflux gastritis were infected with Helicobacter pylori and accounted for 32%,which was lower than 61.9% in those without bile reflux.Conclusion Cholecystectomy appears to be correlated with bile reflux which may result in various esophageal and gastroduodenal mucosal diseases.Endoscopy and pathologic examination can play important roles in the diagnosis of bile reflux.There are not obvious relationship between Helicobacter pylori infection and bile reflux gastritis.

关 键 词：胆囊切除术 胆汁反流 胃十二指肠 病理检查 

分 类 号：R575.6[医药卫生—消化系统]