容易误诊的孤立性胃十二指肠克罗恩病二例诊疗回顾分析  

Retrospective Analysis of 2 Misdiagnosed Patients with Isolated Gastroduodenal Crohn Disease

作　　者：宁晓燕[1] 王伟福[1] 陈晓武[1] 蔡少薇[1] 黎丽旋[1] 王晋涛[1] 付延玉[1] 许鸣[1] NING Xiao-yan WANG Wei-fu CHEN Xiao-wu CAI Shao-wei LI Li-xuan WANG Jin-tao FU Yan-yu XU Ming(Department of Gastroenterology, the Second People＇s Hospital of Guangdong Province, Guangzhou 510317, China)

机构地区：[1]广东省第二人民医院消化科,广州510317

出　　处：《临床误诊误治》2017年第1期21-24,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的总结孤立性胃十二指肠克罗恩病(Crohn's disease,CD)的临床特征及诊治经验。方法回顾性分析我院收治的2例孤立性胃十二指肠CD临床资料。结果 2例孤立性胃十二指肠CD患者均为男性青年,表现为胃流出道梗阻症状,例1伴腹痛及呕血,起病3 d后行阑尾切除术,术后7 d确诊胃十二指肠CD;例2伴体重下降及轻度贫血、低蛋白血症,按消化性溃疡治疗无效,起病2月余才确诊十二指肠CD。2例胃镜表现为胃和(或)十二指肠黏膜充血水肿及多发溃疡,十二指肠黏膜铺路石样增生隆起,病理组织学检查见大片增生肉芽组织和裂隙状溃疡、小脓肿形成等,消化道造影及肠镜未提示回结肠病变。确诊后给予糖皮质激素冲击治疗,患者症状迅速缓解,短期内复查胃镜示病变明显减轻。结论孤立性胃十二指肠CD多表现为胃流出道梗阻症状,可伴出血、营养不良,应注意和消化性溃疡鉴别,糖皮质激素治疗起效快,疗效确切。Objective To summarize clinical features and experiences of diagnosis and treatment of isolated gastrodu- odenal Crohn disease （CD）. Methods Clinical data of 2 isolated gastroduodenal CD patients was retrospectively analyzed. Results The 2 isolated gastroduodenal CD patients were all young male, and the main symptom was gastric outlet obstruc- tion. One patient had accompanied with belly ache and haematemesis, and underwent appendicectomy at 3rd d after onset, and was confirmed gastroduodenal CD on 9-h d after surgery. Another patient had accompanied with weight loss, mild anemia and hypoalbuminemia, and treatment for peptic ulcer was noneffective, and was confirmed gastroduodenal CD in more than 2 months after onset. Gastroscopes examination for the 2 patients showed that hyperemia, edema and muitiple ulcers in the stom- ach and/or duodenum mucous membrane, and cobble-like hyperplasia in duodenum mucous membrane. The histopathological examination showed granulation tissues, fissuring ulcers and small abscesses in mucosa and submucosa. Digestive tract radio- graphy and colonoscopy examination showed that there was no ileocolon lesion. Pulse glucocorticoids therapy was performed for the 2 patients after confirming isolated gastroduodenal CD. Symptoms were relieved quickly, and gastroscopy examination showed the lesions had remarkable alleviated in a short time. Conclusion Clinical manifestations of isolated gastroduodenal CD include gastric outlet obstruction, and accompanied with bleeding and malnutrition sometimes, and therefore differential diagnosis with peptic ulcer should be made.

关 键 词：CROHN病 胃疾病 十二指肠疾病 误诊 消化性溃疡 

分 类 号：R574[医药卫生—消化系统]