先天性幽门前瓣膜症的胃镜特征与临床诊断

目的 探讨幽门前瓣膜症的胃镜特征与临床诊断.方法 回顾分析18例经手术证实的幽门前瓣膜症患儿的临床特点、胃镜表现和手术所见.结果 胃镜检查显示18例均有不同程度的胃潴留和幽门梗阻,其中合并食管糜烂和(或)食管溃疡4例,糜烂出血性胃炎5例,胃窦溃疡、胃角溃疡、幽门口溃疡各1例.18例中幽门前区中心孔样狭窄2例;幽门前区黏膜充血水肿明显,狭窄口周围黏膜呈均匀一致环状隆起,中央凹陷似"火山口"样改变的9例,其中3例可见突向腔内的环形黏膜瓣.上述11例手术所见瓣膜分别位于幽门口或幽门管,均行瓣膜切除并幽门成形术.其余7例胃窦远端黏膜皱襞粗大,向近心端呈辐状排列,中央可见类圆形或不规则形狭窄孔,手术证实为幽门窦部瓣膜,瓣膜分别距幽门十二指肠交界处1～3 cm的胃窦部,均行单纯瓣膜切除术.结论　先天性幽门前瓣膜症为少见病,临床易误诊、漏诊,症状出现的早晚和严重程度取决于瓣膜孔径的大小.对间歇性无胆汁样呕吐的患儿,除进行钡餐造影外,还应及早进行胃镜检查.胃镜检查可避免造影的假阳性,对明确诊断及手术定位有重要价值.

Clinical manifestations and endoscopic findings of congenital prepyloric membrane

Objective To study gastroscopic features and clinical diagnosis of prepyloric mem-brane. Methods Clinical characteristics,gastroscopic manifestation and operational findings of 18 pa-tients,whose prepyloric membrane have been confirmed by operations,were retrospectively reviewed. Results Gastroscopie findings showed that all the 1 8 patients suffered gastric retention and pyloric obstruc-tion to some degree,with 4 cases of esophageal erosion and/or esophageal ulcer,five cases of erosive hemor-rhagic gastritis,one case of ulcer at gastric antrum,gastric comer and pylorus respectively. There were 2 ca-ses of aperture like narrowing in prepyloric region. And there were 9 cases that showed obvious congestion and edema in the prepyloric mucus,with uniform circular mucusal protrusion around the stenosing stoma,and volcano-like depression in the middle,three cases of which showed mucosal membrane standing out to the gastric cavity. The membrane found in the above 11 cases located in pyloric exit or tube,and they under-went membrane excision and py|oroplasty. The other 7 cases showed thick mucosal folds at the distal antrum with radial arrangement. Round or irregular stenosing stoma were observed. These cases proved to be antral membrane,1-3 cm away from the duodenum and pylorus,and underwent simple membrane resection. Conclusion Congenital prepyloric membrane is rare and it likely mis-diagnosed. The onset and the degree of symptoms depend on the diameter of aperture of the membrane. Early endoscopy,in addition to barium contrast,should be performed on those children who have intermittent bilious vomiting,where false-positive radiological findings can be avoided,therefore,to facilitate right diagnosis and appropriate operation.