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1 病例报告 例l:男,28岁,上腹部无规律性疼痛2年,餐后腹胀,近月余饭后常呕吐,吐物为隔餐或隔夜饮食,无发热、腹泻史。体检:消瘦、脱水,全身浅表淋巴结无肿大。心肺正常,上腹饱满,可见胃蠕动波,剑突下偏右触及一鸭蛋大包块。肝、脾、肾、外生殖器及运动系统无异常。ESR42mm/h,stood—“OB”(+),其余实验室检查未见异常。X线检查:心肺正常,钡餐后6小时胃潴留90％,幽门部有一团块状充盈缺损。临床诊断:幽门管肿瘤并幽门梗阻。行剖腹探查,术中见胃窦部有5×5×3cm包块,向胃腔增殖突出,胃上及幽门上淋巴结肿大。腹腔其他脏器未见病理改变。术中疑为胃窦癌,做胃次全切除并清扫胃周淋巴结,结肠前胃空肠吻合。术后病理报告:胃结核。住院抗痨1个月,出院后坚持治疗半年,于术后第2、3、4年随访,身体恢复良好。病理检验:胃窦部包块5×5×3cm,呈银灰色,质硬,中心部分坏死。境下见切面为多数结核结节,结节中央为干酪样坏死,周围绕以许多上皮样细胞及郎罕氏细胞。病理诊断:胃窦结核。
1 case report l: male, 28 years old, irregular upper abdominal pain for 2 years, postprandial bloating, vomiting after meals in recent months, spit food or overnight meal, no fever, diarrhea history. Physical examination: weight loss, dehydration, systemic superficial lymph nodes without swelling. Cardiopulmonary normal, full upper abdomen, gastric motility can be seen waves, the right xiphoid touch and a large duck block. No abnormal liver, spleen, kidney, external genitalia and motor system. ESR42mm / h, stood- “OB” (+), the other laboratory tests showed no abnormalities. X-ray examination: normal lung and heart, gastric obstruction 6 hours after barium 90%, pyloric lumps filled with a defect. Clinical diagnosis: pyloric tumor and pyloric obstruction. Laparotomy exploration, intraoperative see gastric antrum 5 × 5 × 3cm mass, prominent proliferation to the gastric cavity, stomach and pylorus lymph nodes. No other pathological changes in other organs of the abdominal cavity. Surgery suspected gastric antrum cancer, gastric subtotal resection and dissection of lymph nodes around the stomach, anterior gastrojejunostomy colon. Postoperative Pathology Report: Gastric Tuberculosis. Hospitalization of anti-tuberculosis 1 month, insisted on treatment after discharge for six months, at the second, third and fourth year follow-up, the body recovered well. Pathological examination: gastric antrum mass 5 × 5 × 3cm, was silver gray, hard, the central part of necrosis. Under the scene to see the section for the majority of tuberculosis nodules, central case of caseous necrosis, surrounded by many epithelial cells and Langerhans cells. Pathological diagnosis: gastric sinus.