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目的探讨结节型十二指肠炎内镜下表现与其组织学特征的关系及其发病机制。方法观察内镜下136例结节型十二指肠炎的表现,对其活检标本均行H-E染色,观察病理改变,Giemsa染色及快速尿素酶试验诊断幽门螺杆菌感染,十二指肠黏膜兼作AB/PAS染色,观察十二指肠胃上皮化生。结果136例结节型十二指肠炎内镜下表现为直径0.2~1.0cm大小不等的结节,伴有不同程度的充血、水肿,其中伴糜烂21例,出血点及(或)瘀斑30例。检出率占同期15820例内镜检查的0.9%,十二指肠炎的3.8%。病理诊断为十二指肠炎107例,其中慢性十二指肠炎53例,表现为间质内可见慢性炎性细胞浸润,肠绒毛缩短或萎缩、变平,肠腺不同程度减少;活动性十二指肠炎54例,除慢性炎性细胞外,黏膜层及固有层内还有不同程度的中性粒细胞浸润,伴Brunner腺增生51例,胃型上皮化生59例。136例中检出胃黏膜异位增生7例以及血吸虫虫卵所致的炎性病变4例,107例结节型十二指肠炎中,幽门螺杆阳性(Hp+)者为45.8%(49/107)。其中,53例慢性十二指肠炎患者中Hp+者为32.1%(17/53),54例活动性十二指肠炎中Hp+检出率为59.3%(32/54),后者的Hp+检出率显著高于前者(P<0.01)。结论结节型十二指肠炎是一类特殊的非特异性十二指肠炎,内镜下表现与组织学改变存在不一致性。其发生可能与Hp感染及胃上皮化生、Brunner腺增生有关。
Objective To investigate the relationship between the endoscopic features of nodular duodenal inflammation and its histological features and its pathogenesis. Methods The endoscopic findings of 136 cases of nodular duodenitis, the biopsy specimens were HE staining, pathological changes observed, Giemsa staining and rapid urease test for the diagnosis of Helicobacter pylori infection, duodenal mucosa also served as AB / PAS staining, observe duodenal gastric metaplasia. Results 136 cases of nodular duodenitis showed endoscopic nodules of 0.2 ~ 1.0cm in diameter, with varying degrees of congestion and edema, including 21 cases of erosion, bleeding and / or ecchymosis 30 cases. The detection rate accounted for 0.920% of 15,820 endoscopy in the same period and 3.8% of duodenal inflammation. Pathological diagnosis of 107 cases of duodenal inflammation, including 53 cases of chronic duodenitis, showed interstitial inflammatory cells can be seen in the infiltration of the intestinal villi shortened or atrophied, flattened, varying degrees of reduced intestinal glands; activity of twelve 54 cases of enteritis, in addition to chronic inflammatory cells, mucosal and lamina propria there are varying degrees of neutrophil infiltration, with Brunner gland hyperplasia in 51 cases, 59 cases of gastric epithelial metaplasia. In 136 cases, gastric mucosal ectopic hyperplasia was detected in 7 cases and in schistosomiasis eggs in 4 cases. In 107 cases of nodular duodenitis, the positive rate of pyloric screw was 45.8% (49/107 ). Among them, Hp + was found in 32.1% (17/53) of 53 patients with chronic duodenitis, and Hp + was detected in 54.3% (32/54) of 54 patients with active duodenitis. Hp + The rate was significantly higher than the former (P <0.01). Conclusions Nodular duodenitis is a special type of nonspecific duodenitis with inconsistent endoscopic findings and histological changes. Its occurrence may be related to Hp infection and gastric metaplasia, Brunner gland hyperplasia.