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目的探讨儿童十二指肠球部多发隆起性病变的内镜下特点及其与临床的关系。方法观察34例十二指肠球部多发隆起性病变患儿(病变组)的内镜下特点,并以20例内镜下球部基本正常患儿作为对照组。对活检标本行组织染色检查。2组患儿中幽门螺杆菌(H.pylori)阳性者接受三联根除治疗(奥美拉唑+克拉霉素+阿莫西林.克拉维酸钾)14d,随后仅以奥美拉唑治疗2周;而H.pylori阴性者接受奥美拉唑治疗1个月。2组均于停药后4周复查胃镜。比较治疗前后胃镜下隆起性病变程度及组织学变化,分析H.pylori感染与胃镜下表现及组织学异常的关系。结果 75.0%对照组患儿组织学表现为轻度慢性炎性改变,胃窦部H.pylori感染率25.0%。病变组患儿内镜下表现为十二指肠球部多个广基息肉状隆起,病理检查均显示为慢性十二指肠炎,胃窦部H.pylori检出率为100%(与对照组比较,P<0.05)。54例纳入者均复查胃镜,病变组患儿十二指肠球部多发隆起性病变消退(11/34,32.4%)或减轻(23/34,67.6%),同时组织病理学显著改善(与治疗前比较,均P<0.05),但与H.pylori根除无关(P>0.05)。对照组治疗前后组织学改变无统计学意义(P>0.05)。结论儿童十二指肠球部多发隆起性病变均为慢性炎症所致的良性病变并与高H.pylori感染率相关。抑酸治疗可使炎症显著减轻,隆起性病变消退/减轻。
Objective To investigate the endoscopic features of multiple ductile lesions in children with duodenal bulb and their clinical significance. Methods The endoscopic features of 34 cases with multiple bulging lesions in the duodenal bulb were observed. Twenty children with normal basal ball under endoscopy were selected as the control group. Tissue staining biopsy specimens were examined. H.pylori-positive children in the two groups received triple eradication therapy (omeprazole + clarithromycin + amoxicillin-clavulanate potassium) for 14 days followed by omeprazole alone for 2 weeks ; While H.pylori-negative patients received omeprazole for 1 month. Two groups were examined gastroscope 4 weeks after withdrawal. The degree of histopathological changes and histopathological changes in patients underwent endoscopy were compared before and after treatment. The relationship between H.pylori infection and endoscopic findings and histological abnormalities was analyzed. Results The histopathological changes of 75.0% of the control group were mild chronic inflammatory changes. The infection rate of H.pylori in gastric antrum was 25.0%. Lesions in children with endoscopic manifestations of multiple wide-base duodenal bulbous meat-like uplift, pathological examination showed chronic duodenitis, H.pylori gastric antrum was detected in 100% (compared with the control group Comparison, P <0.05). Gastroscopy was performed in all 54 cases, and the lesions of the duodenal area in the diseased group subsided (11/34, 32.4%) or alleviated (23/34, 67.6%), while histopathology was significantly improved Before treatment, all P <0.05), but not with H.pylori eradication (P> 0.05). The histological changes in the control group before and after treatment were not statistically significant (P> 0.05). Conclusions Multiple duodenal bulge lesions in children are benign lesions caused by chronic inflammation and are associated with high H.pylori infection rate. Acid suppression can significantly reduce the inflammation, bulging lesions subsided / relieved.