十二指肠粘膜胃上皮化生的诊断及临床意义

目的：探讨十二指肠粘膜胃上皮化生的诊断及临床意义。方法：对58例经胃镜检查确诊的十二指肠球部溃疡患者行十二指肠美蓝染色，于不染区或着色区取材作病理检查和快速尿素酶试验。结果：58例患者中，26例于溃疡附近出现斑片状粉红色不染区，13例出现白色不染区，19例着蓝色，三者的胃上皮化生检出率分别为80．8％（21／26），15．4％（2／13）和10．5％（2／19），粉红色不染区的胃上皮化生检出率明显高于着色区（P＜0．01），25例检出胃上皮化生者中22例幽门螺杆菌（H.pylori)阳性（88．0％），33例无胃上皮化生者中4例H.pylori阳性（12．1％），前者的阳性率显著高于后者（P＜0．01），结论：十二指肠美蓝染色用于辨别十二指肠胃上皮化生效果较好，对针对性取材及观察十二指肠球部溃疡患者胃上皮化生的动态变化有指导意义。

Diagnosis and Clinical Significance of Gastric Metaplasia in Duodenal Mucosa

Background/Aims: To investigate the diagnosis and clinical significance of gastric metaplasia in duodenal mucosa. Methods: Duodenal methylene blue staining was performed in 58 patients with duodenal ulcer diagnosed with gastroscopy. Biopsies taken from unstained and blue-stained duodenal mucosal areas were examined with histologic method and rapid urease test. Results: Among them, 26 patients showed unstained pink areas in duodenum, 13 showed unstained white areas and 19 were bluestained and their gastric metaplasia rates were 80.8% (21/26), 15.4% (2/13) and 10.5% (2/19), respectively. The unstained pink duodenal areas had more gastric metaplasia than the blue-stained areas (P<0.01). Tissues in gastric metaplasia areas showed definite reaction with Helicobacter pylori (22/25, 88.0%) which was more obvious than those with absence of gastric metaplasia (4/33, 12.1%; P<0.01). Conclusions: Methylene blue staining of the duodenum is useful to identify and observe the dynamic changes of gastric metaplasia.