胃镜确诊的十二指肠球部溃疡123例胃电图分析

近年来，胃电图检查广泛用于临床单位，其对胃肠疾病的诊断价值尚有争议。我院近2年进行胃电图检查700多例，其中123例经纤维胃镜检查证实为十二指肠球部溃疡，现将这组患的胃电图表现作临床分析。     

2614例十二指肠球部溃疡的临床及胃镜分析

我们通过内镜图文处理系统收集了我科1999年至2002年间41174例胃镜检查资料，其中十二指肠球部溃疡2614例，占6．35％，现报道如下。     

十二指肠球部腺癌1例

1 病例 患者女,74岁,因左上腹部饱胀不适伴呕吐、进行性消瘦1月余入院.既往否认胃病史.嗜烟酒50余年.入院查体:生命体征尚可,轻度贫血貌.心肺无明显异常.上腹饱满,左上腹部轻度压痛,无反跳痛和肌卫,振水音阳性,未扪及明显包块,肝脾肋下未触及;肝区无叩击痛;移动性浊音阴性.B超示胆囊萎缩,肝胰脾未见异常.     

胃镜诊断十二指肠球部溃疡并穿孔1例

消化性溃疡是内科常见病，常经胃镜检查确诊。但经胃镜诊断溃疡病合并穿孔，尚少见报道。现将笔者所见1例报告如下。     

胃镜下合金钛夹治疗十二指肠球部溃疡大出血

我院自2000年11月至今，在胃镜下应用合金钛夹治疗十二指肠球部溃疡大出血7例，均取得了满意的止血效果，并且有效地防止了再出血，使患者免除了手术之苦。     

十二指肠球部结核一例

患者女．42岁。因上腹痛20d．加重3d入院。20d前无明显诱因出现上腹阵发性隐痛，餐后加重．无放射痛，无其他胃肠道症状．无发热。体重下降5kg。20年前患肺结核，经抗结核治疗后已愈。体检：体温37℃．脉搏82次／min，呼吸18次/min，血压130/85mmHg（1mmHg=0.133kPa）；心肺未及异常，除左上腹及脐周压痛外无其他腹部阳性体征。     

内镜取出十二指肠球部活体钩虫3例

病例报告例1男，52岁内镜号960891，临床疑诊消化性溃疡出血，于1996．09－16内镜检查，术中见慢性浅表性胃炎，幽门线形溃疡，同时见十二指肠球部散在少许出血点，大弯测距由f73crn处，见一直径Zrnm，长约0．scrn线虫吸附球壁，虫体略透明，肉红色，尾部活动，随即用活俭钳取出，胃液无色透明，PH5．例2女，57岁．内镜号970157，因严重贫血查因而住院，1997－02－24内镜检查，胃内无特殊，十二指肠球部散在少许针尖大小出血点，大弯侧近前壁同一处吸附两条线样虫体，直径Zto，长约lgn。1．回m，。大。／h，合抱呈“人”字形，虫体肉红色…     

十二指肠钩虫和美洲钩虫鉴定方法研究进展

钩虫是肠道寄生线虫中危害最严重的虫种,据估计 ２０１０ 年全世界钩虫感染人数约 ４ 亿。 感染人体的钩虫主要有美洲钩虫和十二指肠钩虫,两种钩虫的虫种鉴定在钩虫病的流行病学研究、钩虫病的防治策略制定、临床用药和寄生虫教学均具有重要的指导意义。 目前实验室对两种钩虫的鉴定方法主要有形态学观察、免疫学检测和分子生物学检测。 本文就两种钩虫的鉴定方法研究进展作一综述。     

Heterotopic gastric tissue in the duodenal bulb

Heterotopic gastric tissue in the duodenal bulb is a rare congenital lesion. Its prevalence has been reported to be 0.5-2%. It must be differentiated from gastric metaplasia of the duodenal bulb because the two entities have different clinical implications. During one year, we found three cases of gastric heterotopia of the duodenal bulb. In one of the cases, active acid-secreting gastric mucosa was documented by performing the pentagastrin Congo red dye test. The differences between gastric heterotopia of the duodenal bulb and gastric metaplasia of the duodenal bulb have been discussed.     

Gastric metaplasia in duodenal bulb andCampylobacter-like organisms in development of duodenal ulcer

Multiple biopsies were taken from 50 patients with endoscopic appearance of duodenitis in order to study the relationship between gastric metaplasia in duodenum and the presence ofCampylobacter-like organisms (CLOs) and the development of duodenal ulcer disease. Metaplasia was found in at least one biopsy specimen from 46 of the 50 patients; CLOs were seen in 25 of the 50 patients, only in metaplastic areas. In four cases a transitional epithelium with the presence of cells containing few apical mucoid granules and absorbent-type brush border as well as goblet cells was seen. In two cases, this epithelium was colonized by a small number of CLOs. Gastric heterotopia appears to be a rare condition.     

Carcinoma of duodenal bulb arising from the Brunner’s gland

A 75-year-old man was diagnosed as having a sessile tumor measuring 1.4 x 1.0 cm in size in the duodenal bulb after upper gastroduodenal series. The biopsy specimens revealed a proliferation of the adenomatous glands showing an acinar structure with papillary infolding; type III mucus, which is characteristic of Brunner’s glands. Antral glands and mucus neck cells of the fundic glands were also observed in the adenomatous glands by concanavalin A staining. Thus, it was clear that the tumor had originated from the Brunner’s glands. Three years and four months later, the sessile tumor had developed into a fungating ulcerated tumor via a polypoid form. The biopsy specimens revealed a papillary adenocarcinoma with foci of undifferentiated carcinoma. Retrospectively, the adenomatous glands in the biopsy taken from the sessile tumor should have been regarded as low grade carcinoma. Therefore, we propose that when a polyp or tumor shows an increase in size or change in macroscopic appearance, surgery should be considered.     

Duodenal bulb acidity in patients with duodenal ulcer

Intraluminal pH was measured simultaneously in the human stomach and proximal duodenum with six small glass electrodes tied together at 1.5-cm intervals. Twenty-four healthy control subjects and 44 patients with duodenal ulcer disease were studied under fasting conditions and for 3 h after a standard liquid meal. Mean and median hydrogen ion activity, percentage of time with pH below 2 and 3, and the frequency of pH fluctuations were calculated from digital pH data sampled at a frequency of once per second from each electrode. None of these measurements of acidity differed significantly between the two groups or between subgroups of normosecretor controls and hypersecretor ulcer patients. At the time of pH study 15 of the patients had endoscopically verified active ulcer disease and 13 patients were without disease activity. Gastric as well as duodenal bulb acidity was the same in these two subgroups. We conclude that even though duodenal ulcer patients deliver more acid into the duodenum, this does not cause increased luminal acid aggression.     

Successful treatment of life-threatening bleeding from a duodenal posterior bulb peptic ulcer by an over-the-scope-clip

Bleeding of peptic ulcer at the posterior duodenal bulb still is a particular endoscopic challenge with increased risk of treatment failure and worse outcome.In this article,we report successful treatment of an actively bleeding peptic ulcer located at the posterior duodenal wall,using an over-the-scope-clip in the case of a 54-year-old male patient with hemorrhagic shock.Incident primary hemostasis was achieved and no adverse events occurred during a follow-up of 60 d.     

Acute upper gastrointestinal hemorrhage caused by gallstone impaction in the duodenal bulb

Summary An unusual case of upper gastrointestional hemorrhage caused by gallstone impaction in the duodenal bulb (Bouveret's syndrome) is reported. Endoscopy was used to make the diagnosis rapidly and surgery was performed to provide definitive treatment. Bouveret's syndrome must be kept in mind as a rare cause of upper gastrointestinal hemorrhage.