摘要
目的探讨难治性十二指肠球部溃疡的病因,提高对十二指肠球部溃疡与肿瘤并存临床特点的认识,减少误诊率及漏诊率。方法收集临床资料完整并行病理活检的6例十二指肠球部溃疡伴发肿瘤患者的临床资料,分别从临床表现、实验室检查、影像学、病理学、治疗与转归等方面归纳总结,并结合文献进行分析。结果 6例患者术后均证实为十二指肠球部溃疡伴发肿瘤,其中5例合并有不同程度幽门梗阻。并有病程治疗时间长、病情反复、体质量下降、营养不良等表现,内镜检查为十二指肠球部溃疡,病理活检诊断多为慢性炎症、溃疡,需要反复多次病理活检,甚至行外科手术病理检查方可确诊。临床误诊、漏诊率较高。结论难治性十二指肠球部溃疡应警惕合并肿瘤的可能,内镜检查是目前明确诊断的主要手段,但误诊、漏诊率较高。提高对本病的认识,重视反复多次病理活检是降低误诊、漏诊率的关键。
Objective To explore the causes of refractory duodenal ulcer and to improve the awareness of clinical characteristics of duodenal ulcer associated with tumors for reducing the rates of misdiagnosis and missed diagnosis. Methods Clinical data of 6 patients with duodenal ulcer associated with tumors who underwent biopsy were collected. Clinical manifestations, laboratory tests, imaging, pathology, treatment and prognosis were summarized and analyzed based on comprehensive literature review. Results Duodenal ulcer associated with tumors was confirmed in all the 6 patients. Among them, different degrees of pyloric obstruction occurred in 5. Patients had long illness duration and disease recurrence. Clinical manifestations included body weight loss, malnutrition, etc. Endoscopy showed duodenal bulbar ulcer. Pathological biopsy showed chronic inflammation and ulcer and should be performed repeatedly. Even surgery was needed to identify the disease. There were high rates of misdiagnosis and missed diagnosis. Conclusion Refractory duodenal ulcer is probably associated with tumors. Endoscopy is the primary means of diagnosis, but results in high rates of misdiagnosis and missed diagnosis. The key to reducing the rates of misdiagnosis and missed diagnosis is to improve the awareness of the disease and to pay attention to repeated pathological biopsy.
出处
《实用临床医学（江西）》
CAS
2013年第6期22-25,共4页
Practical Clinical Medicine
