内衬异位胃黏膜的直肠憩室1例并文献复习  

Rectal diverticulum lined with ectopic gastric mucosa:one case report with a literature review

作　　者：闫俊[1] 张丹[1] 庞文博[1] 陈亚军[1] Yan Jun;Zhang Dan;Pang Wenbo;Chen Yajun(Department of General Surgery,Affiliated Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院普外科,北京100045

出　　处：《中华小儿外科杂志》2024年第1期47-52,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨内衬异位胃黏膜的直肠憩室的临床特点、诊治方式及预后,为研究消化道畸形提供方向。方法回顾性分析1例由首都医科大学附属北京儿童医院诊治的内衬异位胃黏膜的直肠憩室患儿临床资料。患儿,男,11岁5个月,因间断便血伴贫血5年余入院,经结肠镜检查+直肠憩室黏膜剥除术确诊并治疗直肠前侧壁憩室型重复畸形。以"直肠重复畸形""直肠憩室""异位胃黏膜"及其英文"rectal duplication""rectal diverticulum""ectopic gastric mucosa"为关键词,检索于1960年至2022年发表并收录于万方、维普、中国知网、中国生物医学文献服务系统及PubMed的相关文献并行文献复习。结果本例患儿手术顺利,术后病理诊断为直肠重复畸形,重复肠管被覆胃黏膜。术后随访12个月,未再出现便血症状,大小便正常。文献检索到4例内衬异位胃黏膜的直肠憩室,结合本组1例,共5例患儿。所有患儿均表现为便血,行一期根治性病灶切除手术后随访12~36个月,症状消退,预后良好。结论内衬异位胃黏膜的直肠憩室,病变特点符合消化道重复畸形的现行诊断标准,建议统一命名为"憩室型直肠重复畸形",以描述其先天发育性、真性憩室病变的临床特点。异位胃黏膜具备分泌胃酸能力,是其导致便血的根本原因,手术切除疗效确切。建议开展对消化道黏膜上皮黏蛋白及细胞角蛋白的研究以揭示内衬异位胃黏膜的直肠憩室的发病机制。Objective To explore the clinical features,treatments and outcomes of rectal diverticulum lined with ectopic gastric mucosa and provide rationales for managing digestive tract developmental malformations.Methods A boy aged 11 years and 5 months was hospitalized for intermittent hematochezia and anemia for over 5 years.A definite diagnosis of rectal diverticulum lined with ectopic gastric mucosa was confirmed after colonoscopy and radical mucosal stripping.The English and Chinese literature items published between 1960 and 2022 with such keywords as"rectal duplication","rectal diverticulum"and"ectopic gastric mucosa",were retrieved from the databases of Wanfang,VIP,CNKI,China Biomedical Literature Service System and PubMed.Results In this case,operation was successful,and postoperative pathological diagnosis was diverticular rectal duplication lined with ectopic gastric mucosa.After a follow-up period of 12 months,there was no recurrence of hematochezia.Both urination and bowel movement were normal.The literature retrieval found 4 children with rectal diverticulum lined with ectopic gastric mucosa.All children of hematochezia underwent one-stage radical lesion resection.After a follow-up period of 12 to 36 months,all symptoms subsided.Conclusions The pathological characteristics of rectal diverticula lined with ectopic gastric mucosa are in line with the current diagnostic criteria for alimentary tract duplication.Thus a unified nomenclature of"diverticular rectal duplication"is proposed for describing the clinical features of congenital developmental and true diverticular malformation.Ectopic gastric mucosa,secreting gastric acid,is a primary cause of hematochezia and surgical resection remains effective.It is recommended to examine mucin and cytokeratin of digestive mucosa to elucidate the underlying pathogenesis of rectal diverticulum lined with ectopic gastric mucosa.

关 键 词：胃黏膜 异位胃黏膜 结直肠憩室 黏蛋白 细胞角蛋白 

分 类 号：R726.5[医药卫生—儿科]