胃嗜酸性肉芽肿若干临床问题探讨：附33例报告

本文分析了３３例胃嗜酸性肉芽肿（ＧＥＧ）的临床、Ｘ线、胃镜、手术及病检结果。讨论了ＧＥＧ的病因、诊断及治疗。认为ＧＥＧ是在慢性胃炎或胃溃疡的基础上机体对食物或药物产生的局部过敏反应，由于反应强烈程度不尽相同，导致了大体形态差异给诊断造成困难，因而Ｘ线、胃镜甚至手术中常误诊胃溃疡或胃癌。强调胃镜挖掘（ｅｘｃａｖａｔｉｏｎ）式活检对术前确诊及术后多部位取材对排除癌变的重要性。对激素治疗持异议，主张手术治疗以避免穿孔、出血乃至癌变的遗漏。     

老年胃嗜酸性肉芽肿15例报告

胃嗜酸性肉芽肿是一种原因不明的瘤样增生性病变 ,发生于老年人可能与其生理特点及长期胃溃疡的刺激有关 ,现将我们诊治的 15例老年人胃嗜酸性肉芽肿报道分析如下。1　临床资料本组 15例均为男性 ,年龄 6 1～ 6 5岁10例 ,6 6～ 71岁 5例。病程 3～ 5年 8例 ,8～ 10年 3例 ,14～ 2 0年 3例 ,30年 1例。15例均有上腹隐痛 ,反酸嗳气等一般胃病表现 ,其中伴呕血史者 3例 ,黑便史者9例 ,伴频繁呕吐等幽门梗阻症状 2例。曾患过血吸虫病 10例 ,均经治疗已愈。15例均经Ｘ线钡剂检查 ,其中诊断胃溃疡 9例 ,胃癌 6例。经纤维胃镜检查 9例 ,其中诊断胃…     

胃嗜酸性肉芽肿11例临床分析

胃嗜酸性肉芽肿在临床上较为少见,因其病变及临床表现无特异性,往往造成诊断上的困难。现将我院所见11例分析报告于下。     

幽门螺杆菌感染与胃嗜酸性肉芽肿发病相关性的初步研究

胃嗜酸性肉芽肿(GEG)是一种以胃黏膜下层及肌层大量嗜酸细胞浸润为特征的良性病变。其病因及发病机制目前尚不清楚。幽门螺杆菌(Hp)感染几乎与所有胃部疾病发病有关，但在GEG发病中的作用尚鲜见报道。本文旨在初步探讨Hp感染与GEG发病的关系。     

结肠嗜酸性肉芽肿一例

患者女 ,6 5岁 ,以间歇性血便 2周就诊。患者 2周内出现 2次血便 ,血便呈喷射状鲜红色 ,无其他伴随症状。既往30年前因子宫肌瘤行子宫切除术。门诊行纤维结肠镜检查见距肛门 35ｃｍ处有一肿物突向肠腔 ,表面溃烂 ,上覆污秽苔 ,绕肠壁 4 / 5周 ,质脆 ,易出血 ,该段肠管狭窄。取活检 ,病理示 :坏死渗出物中可见核异质 (癌疑 )细胞。术前诊断乙状结肠癌 ,行剖腹探查术。术中见腹腔内肠管广泛黏连 ,腹腔内实质脏器未见癌转移灶 ,无肿大淋巴结 ,探查左半结肠未发现肿物 ,分解黏连后重新探查仍未发现肠管壁异常。考虑到分解黏连后左半结肠肠壁有轻…     

嗜酸性淋巴肉芽肿一例

嗜酸性淋巴肉芽肿是一种罕见的病因不明的全身淋巴结肿大伴嗜酸性粒细胞增多、病程是慢性良性过程的疾病。国内最早由金显宅1937年报告，以后浙江、四川、湖南、福建等省陆续发现，本人在海南省人民医院工作期间见到1例，报告如下。1病例介绍患者男，30岁。因反复皮疹5年，周身     

Endoscopic findings and pathologic characteristics of gastric eosinophilic granuloma： A report of 18 patients

INTRODUCTION Gastric eosinophilic granuloma (GEG) is characterized by pathological changes including eosinophil cells infiltrated into the submucous layer and muscular layer of the stom- ach. Its etiology is still unknown. The patients are prone to be mis…     

幽门螺杆菌相关性胃部疾病的病理变迁

目的：探讨幽门螺杆菌（Hp)清除与否与胃黏膜病理转归的关系。方法：191Hp感染的胃炎或溃疡病患者分别随机给予抗Hp或非抗Hp治疗,1年后复查胃镜,病理分型根据悉系统。结果191例患者中,慢性炎症1年后的炎症程度较1年前减轻（P＜0．05）。其中萎缩和肠化生的程度也较前减轻（P＜0．05）,但活性动性炎症和蔼前后比较差异无显著性（P＜0．05）。根据1年后胃镜复查有无Hp清除分为两个队列,Hp清除列有107例,Hp未肖除列有84例,Hp清除列较未清除列1年后慢性炎症程度轻（P＜0．05）活动性炎症者少（P＜0．05）。对不疾病和不同的治疗分层后发现,Hp清除者的胃黏膜炎症程度总是较Hp未清除者轻（P＜0．05）。结论本研究提示,Hp感染与胃黏膜活动性炎症关系较为密切。Hp清除有利于胃黏膜炎症程度的减轻。     

Increase of mast cells may be associated with infiltration of eosinophils and proliferation of microvessels in gastric eosinophilic granuloma

BACKGROUND: Gastric eosinophilic granuloma (GEG) is a rare disease. Recently this disease has begun to increase in China. In the present study, the function and the role of mast cells (MC) in the pathogenesis of GEG were investigated. METHODS: Paraffin-embedded tissue sections from 23 GEG patients and 15 gastric ulcer (GU) patients, were stained with antihuman mast cell tryptase for counting the MC and degranulated MC. Antihuman CD34 antibody was used for detecting the microvessel density (MVD) with immunohistochemical technique. Mast cell degranulation was also studied using electron microscopy. RESULTS: The quantity of both MC and degranulated MC were higher in both GEG and GU than in normal gastric mucosa. The proportion of degranulated MC was higher in the GEG but in GU it was similar to normal mucosa. The MVD was higher in both GU and GEG than that in the normal gastric mucosa and it was higher in the high-MC group than in the low-MC group in GEG. The positive correlation between eosinophil and MC was present only in GEG, not in GU. CONCLUSIONS: The infiltration of eosinophils and MVD may be associated with the increase of MC in GEG. This suggests that in addition to eosinophils, MC might be the important cells in the pathogenesis of GEG.     

根除幽门螺杆菌对胃癌患病率及胃黏膜组织学变化的八年随访研究

目的观察胃癌高发区中幽门螺杆菌(Hp)阳性患者根除Hp后8年的胃癌患病率及胃黏膜组织学变化,探讨Hp感染与胃黏膜组织学变化的关系。方法1996年在胃癌高发区山东烟台市自然人群中整群抽样选择1006例成年人(年龄35～75岁,入组时无胃癌患者)。将Hp阳性患者552例随机分为治疗组(T组,276例)和安慰剂组(P组,276例),采用随机、双盲、安慰剂对照平行试验方法,T组给予奥美拉唑、羟氨苄青霉素和克拉霉素口服治疗1周,P组给予安慰剂对照。停药1个月后行13C尿素呼气试验(13CUBT),T组Hp根除率为89%。再按Hp状况重新分为Hp根除组(246例)和Hp阳性组(306例),分别于1、5、8年后进行内镜复查。将8年后复查胃镜及相同部位胃黏膜组织病理检查与8年前结果进行比较。结果①8年随访共发现7例胃癌患者,Hp根除组1例,Hp阳性组6例,两组胃癌患病率按人年计算:Hp根除组为1/1968人年、Hp阳性组为6/2448人年。用泊松分布比较,两组胃癌患病率差异有统计学意义(P<0.05)。②5年随访时两组胃癌患病率及死亡共6例,Hp根除组1例,Hp阳性组5例,两组胃癌患病率按人年计算:Hp根除组为1/1230人年,Hp阳性组为5/1530人年。用泊松分布比较,两组胃癌患病率差异无统计学意义(P>0.05)。③Hp根除8年后,患者胃体部萎缩进展缓慢,而Hp阳性组患者胃体部萎缩发生率明显增加,两组相比差异有统计学意义(P<0.01)。根除Hp8年后胃窦部萎缩肠化改变两组间差异无统计学意义(P>0.05)。结论Hp感染可增加胃癌发病率,根除Hp有利于减少胃癌发生,并可使胃体部萎缩进展缓慢。持续Hp感染可使萎缩及肠化呈进行性加重。     

幽门螺杆菌感染对胃粘膜超微结构的影响

目的研究幽门螺杆菌（Ｈｐ）感染及其根除前后胃粘膜超微结构的变化．方法Ｈｐ感染患者１０例经三联疗法２８ｄ．Ｈｐ阴转７例于停药１月后及治疗前内镜下取胃窦粘膜，经切片染色后分别行透射电镜及扫描电镜观察．结果透射电镜显示，Ｈｐ聚集处上皮细胞微绒毛变短、减少或消失，细胞呈毛刺状或外突形成分枝状，细胞膜内侧粘液颗粒聚集，细胞破裂，释放粘液颗粒．扫描电镜下Ｈｐ横卧于微绒毛表面或垂直镶嵌在微绒毛里．应用三联疗法（德诺１２０ｍｇ＋四环素０２５ｇ＋呋喃唑酮１０ｍｇ，４次／ｄ）治疗２８ｄ，停药１月后７例Ｈｐ根除．电镜显示Ｈｐ消失，粘膜细胞变性逆转，上皮细胞及微绒毛结构恢复正常．结论Ｈｐ引起的胃粘膜超微结构损害在根除Ｈｐ后有改善及恢复     

胃石及其并发幽门螺杆菌感染相关性胃病的临床诊治分析

对12例胃石在胃镜下用活检钳反复进行钳夹，对合并幽门螺杆菌感染相关性胃病的患者进行抗幽门螺杆菌、抑酸和保护胃黏膜治疗。最后，胃石被夹碎后排出胃腔，幽门螺杆菌被清除，胃溃疡和胃炎得到治愈。     

Influence of Helicobacter pylori on the gastric mucosal barrier

AIM: To study the influence of Helicobacter pylori (Hp) on the gastric mucosal barrier (GMB) by the measurement of the potential difference (PD). METHODS: Fifty seven chronic gastritis cases were diagnosed endoscopically and confirmed by forceps mucosal biopsy. PD was measured by the Takeuchi method, and Hp was detected by both culture (modified Skirrow method) and press printing method with the Giemsa stain. Patients were divided randomly into three groups (De-Nol, WeiTong-Ling, and Placebo) for a course of 6 wk therapy. RESULTS: PD across the mucosa of antrum was significantly lower in Hp (+) patients than in Hp (-) patients (16.44 ± 2.36 vs 19.58 ± 2.44, P < 0.0001). In Hp (+) patients, PD in the antrum increased markedly (16.88 ± 2.56 vs 20.03 ± 2.21, P < 0.0001) after Hp was cleared up by the De-Nol treatment. CONCLUSION: Our data strongly indicated that Hp infection might cause a gastric mucosal barrier to be impaired markedly while the clearance of Hp by De-Nol recovered the integrity of the gastric mucosal barrier significantly.     

幽门螺杆菌感染和吸烟对胃腺癌患者胃蛋白酶原水平的影响

目的　探讨幽门螺杆菌 (H·pylori,简称Hp)感染和吸烟对胃腺癌 (GAC)患者胃蛋白酶原 (PG)水平的影响。方法　PGⅠ、PGⅡ水平用放射免疫法检测 ,用14 C 尿素呼气试验及ELISA法测血清抗Hp IgG抗体确定Hp感染。结果　 (1)Hp阴性吸烟的GAC患者PGⅠ水平均数明显高于Hp阴性不吸烟和曾吸烟的GAC患者 (前者t =2 70 9,P <0 0 5 ;后者t =2 15 7,P <0 0 5 ) ;Hp阳性不吸烟及曾吸烟的GAC患者 ,PGⅠ水平均数明显低于Hp阳性吸烟的GAC患者 (前者 t =2 5 37,P <0 0 5 ;后者t =2 185 ,P <0 0 5 )。 (2 )Hp阴性不吸烟及曾吸烟的GAC患者 ,其PGⅡ水平均数明显低于其Hp阳性不吸烟及曾吸烟的GAC患者 (前者 t =2 94 4 ,P <0 0 1;后者t =2 4 2 7,P <0 0 5 )。结论　吸烟可使GAC患者PGⅠ水平升高 ,停止吸烟后PGⅠ水平均数下降 ;Hp感染可提高不吸烟和曾吸烟患者PGⅡ水平     

Effect of Helicobacter pylori infection on gastric mucosal pathologic change and level of nitric oxide and nitric oxide synthase

AIM: To investigate the level of nitric oxide (NO) and nitrous oxide synthase (NOS) enzyme and its effect on gastric mucosal pathologic change in patients infected with Helicobacter pylori(Hpylori), and to study the pathogenic mechanism of H pylori. METHODS: The mucosal tissues of gastric antrum were taken by endoscopy, then their pathology, H pylori and anti-CagA-IgG were determined. Fifty H pylori positive cases and 35 H pylori negative cases were randomly chosen. Serum level of NO and NOS was detected. RESULTS: One hundred and seven cases (71.33%) were anti-CagA-IgG positive in 150 H pylori positive cases. The positive rate was higher especially in those with pre-neoplastic diseases, such as atrophy, intestinal metaplasia and dysplasia. The level of NO and NOS in positive group was higher than that in negative group, and apparently lower in active gastritis than in pre-neoplastic diseases such as atrophy, intestinal metaplasia and dysplasia. CONCLUSION: H pylori is closely related with chronic gastric diseases, and type Ⅰ Hpylorimay be the real factor for H pylori-related gastric diseases. Infection with H pylori can induce elevation of NOS, which produces NO.     

幽门螺杆菌阳性胃溃疡除菌治疗的临床研究

目的研究根除幽门螺杆菌（Hp）治疗对Hp阳性的胃溃疡愈合率、愈合质量及复发的影响。方法将68例Hp阳性的胃溃疡患者随机分为除菌组和非除菌组，除菌组给予奥美拉唑20mg＋阿莫西林0．5g＋呋喃唑酮0．1g口服，2次／d，1周后奥美拉唑改为20mg，1次／d，共治疗4周。非除菌组单独给予奥美拉唑，剂量方法同上。分别于4周及1年后复查胃镜。结果除菌组和非除菌组比较，4周后溃疡愈合率差异无统计学意义（分别为97．4％和90％，P〉0．05），但两组溃疡愈合质量比较差异有统计学意义。1年后两组溃疡复发率比较，除菌组低于非除菌组，差异有统计学意义（分别为6．7％和59．3％，P〈0．01），Hp根除率除菌组高于非除菌组，差异有统计学意义（分别为86．7％和3．7％，P〈0．01）。结论Hp感染与胃溃疡存在相关性，根除Hp治疗不仅可以提高溃疡的愈合质量，而且还可以减少溃疡的复发。