先天性双幽门伴十二指肠溃疡1例并文献复习  

Congenital double pylorus with duodenal ulcer: A case report and review of the literature

作　　者：袁晓艳[1] 黄颖秋[1] 

机构地区：[1]中国医科大学第五临床学院本溪钢铁(集团)总医院消化内科,辽宁省本溪市117000

出　　处：《世界华人消化杂志》2016年第28期4024-4028,共5页World Chinese Journal of Digestology

摘　　要：先天性双幽门(congenital double pylorus,CDP)是极其罕见的先天性疾病,指2个幽门孔连通胃窦和十二指肠球部.CDP的幽门由正常的黏膜上皮、固有层和黏膜肌层组成,少数CDP手术证实缺乏黏膜肌层但存在异位胰腺组织.本文报道CDP合并十二指肠溃疡1例.患者男,67岁,主诉:反复上腹痛8年,伴黑便6年,再发3 d.血幽门螺杆菌(Helicobacter pylori,H.pylori)抗体(+).8年前胃镜:双幽门(double pylorus,DP)、胆汁返流性胃炎、十二指肠球炎.6年前第1次胃镜:D P、十二指肠球部溃疡性病变,性质待定.病理回报:十二指肠球部黏膜慢性炎症,伴腺体轻度异型增生.6年前第2次胃镜:DP、十二指肠球部溃疡(A2期).本次住院胃镜:DP、幽门管炎.病理回报:幽门管黏膜炎症伴糜烂,轻度肠化.给予该患者PPI联合抗H.pylori治疗,症状明显改善.本病例提示:胃镜检查是诊断CDP最直接、最准确的诊断方法 .Congenital double pylorus（CDP） is an extremely rare congenital disease in which both the prosopyle and apopyle are intercommunicated with the gastric antrum and duodenal bulb. The pylorus of CDP is composed of normal mucous epithelium, the lamina propria, and the muscularis mucosae. However, a few CDP operations have proved the lack of the muscularis mucosae but the existence of heterotopic pancreas tissues in the pylorus of CDP. This article reports a case of CDP complicated with duodenal ulcer in a 67-year-old man. He presented with repeated epigastric pain for 8 years and melena for 6 years, with recurrence for 3 d. He was positive for Helicobacter pylori（H. pylori） antibody. Gastroendoscopy performed 8 years ago revealed double pylorus, bile reflux gastritis, and duodenal bulbar inflammation. Gastroendoscopy performed 6 years ago revealed double pylorus with a duodenal bulbar ulcer lesion, and pathological examination suggested chronic inflammation in the duodenal bulbar mucosa, accompanied with low grade gland dysplasia. A second gastroendoscopy performed 6 years ago also revealed double pylorus with a duodenal bulbar ulcer（A2 stage）. Gastroendoscopy at our hospital revealed double pylorus and pyloric canal inflammation, and pathological examination suggested pyloric canal mucosal inflammation accompanied with erosion and mild intestinal metaplasia. He was then given proton pump inhibitor therapy combined with anti-H. pylori therapy, and his symptoms were obviously improved. This case suggests that gastroendoscopy is the most direct and accurate method for the diagnosis of CDP.

关 键 词：先天性双幽门 十二指肠溃疡 双幽门 后天性双幽门 胃镜 

分 类 号：R573.1[医药卫生—消化系统]