酷似胃癌的嗜酸细胞性胃炎并幽门梗阻一例  

Eosinophilic gastroenteritis with pyloric obstruction strongly resembling stomach cancer:a case report

作　　者：徐琪[1] 汤净[1] 

机构地区：[1]海南医学院第一附属医院消化内科,海口570102

出　　处：《新医学》2017年第5期360-364,共5页Journal of New Medicine

基　　金：海南省科技计划项目(2015SF26)

摘　　要：嗜酸性粒细胞胃肠炎(EG)是一种极其罕见的疾病。该文报道1例EG患者因反复上腹痛1月余,行上腹部增强CT、磁共振胰胆管造影(MRCP)均可见胰头部肿块,MRCP提示此肿块为良性肿瘤的可能性大,两次胃镜检查,均怀疑胃恶性肿瘤,但活组织病理检查未发现肿瘤证据。由于患者梗阻症状加重,恶病质,考虑胃癌可能性大,行腹腔镜探查术,最终依靠腹腔镜探查全胃切除后病理证实为肌层型EG。确诊后予相应治疗,患者好转出院。该例提示以幽门梗阻为表现的EG极其罕见,临床表现不典型,影像学及内镜改变有时类似胃癌,容易被临床医生误诊或漏诊。内镜下多点多次活检,必要时超声内镜指导下进行内镜黏膜下切除术/内镜黏膜下剥离术取大块胃体组织活检,可以提高EG的检出率。Eosinophilic gastroenteritis （ EG） is an extremely rare disease. In this study, we reported one case of EG with complaints about the recurrent upper abdominal pain. The patient received enhanced CT and MRCP of the upper abdomen. MRCP hinted the benign masses in the pancreatic head. Twice gastroscopic examinations suspected the diagnosis of malignant gastric cancer, which was not supported by the findings of pathological biopsy. Due to the aggravation of pylori obstruction and aggressive lesions, the patient was suspec-ted with gastric cancer, and was eventually diagnosed with EG by laparoscopic exploration and total gastrecto-my. The patient was successfully discharged after corresponding treatment. This case hinted that EG patient presenting with pylori obstruction is rarely encountered. It is likely to miss the diagnosis or misdiagnose EG due to non-specific clinical manifestations, imaging and endoscopic signs resembling gastric cancer. Endoscopic multi-point biopsy, if necessary, under the guidance of endoscopic ultrasound endoscopic submucosal resec- tion/endoscopic submucosal dissection of large pieces of gastric biopsy, can improve the diagnostic rate of EG.

关 键 词：嗜酸性粒细胞胃肠炎 胃癌 梗阻型 

分 类 号：R573[医药卫生—消化系统]