175例良性食管溃疡的临床分析

发布时间：2018-06-02 03:18

本文选题：良性食管溃疡 + 病因　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的通过良性食管溃疡临床特点的分析，提高对该病及其病因的认识，做到早期病因诊断、及时治疗、改善预后。方法回顾性分析了我院经胃镜确诊的175例良性食管溃疡患者的临床资料。结果我院内镜室2010年1月至2014年2月经胃镜下检出及病理证实为良性食管溃疡175例，男性124例，女性51例，男：女=2.4：1；年龄范围17~89岁，中位年龄64岁。反流性食管炎所致为主（98例，56%），其次为不明原因（47例，26.86%），食管损伤12例，食管感染8例，炎症性疾病7例，食管黏膜下肿物合并溃疡、贲门失迟缓症、天疱疮各1例。反流性食管炎组以中老年人多见，50岁以上者81例（82.65%），不明原因组，青壮年居多，50岁以下者34例（72.33%），差异有显著统计学意义（P0.005）。本组患者消化系统症状以胸骨后不适、烧心为主（97例，55.43%），其次为反酸、进食梗噎感、吞咽疼痛、吞咽困难、上腹痛、恶心、呕吐、呕血和呃逆等。反流性食管炎组内镜下溃疡多局限于食管下段（88例，89.80%），多发为主（63例，64.28%），溃疡形态以线状、条状多见（71例，72.45%），其次为不规则形、类圆形、环周形等；不明原因组以中段多见（23例，48.93%），多单发（33例，70.21%），溃疡形态以类圆形为主（29例，61.70%），其次为不规则形，条形或纵行等。两组溃疡的分布，差异有显著意义（P0.005）。6例病毒感染多位于中段（3例），多发为主（4例），类圆形或椭圆形（5例），均似“火山溃疡”；3例食管克罗恩病溃疡中下段为主，多发（2例），形态不规则，大小不等，周边有增生或隆起病变，病理未见典型肉芽肿病变；3例食管白塞病，2例中段单发椭圆形和类圆形，1例下段多发纵行；1例可疑嗜酸细胞性食管炎，下段单发类圆形，病理见大量嗜酸性粒细胞浸润；3例药物性食管炎均位于中段，2例单发，类圆形和纵行，1例多发，4处类圆形。Hp检测阳性138例，占84.66%。反流性食管炎组主要伴发疾病为食管裂孔疝（24例），其次为消化性溃疡（13例）、糖尿病、霉菌性食管炎等。反流性食管炎常规治疗后复查46例，30例好转（65.22%），，10例反复，6例进展（3例Barrett，s食管，3例中度不典型增生）；非反流性食管炎复查的不明原因15例，药物性食管炎3例，食管异物5例，放射性食管炎1例常规抑酸、保护黏膜治疗后溃疡愈合，3例病毒感染，抗病毒及常规治疗后好转，2例食管克罗恩病激素治疗后好转，2例食管白塞病，分别激素和沙利度胺治疗后好转，1例贲门失迟缓症钙离子拮抗剂及保护黏膜治疗后好转，1例天疱疮激素及保护黏膜治疗后好转。结论1.反流性食管炎是引起良性食管溃疡的主要原因；2.不明原因良性食管溃疡多发生于青壮年，其发生部位多见于食管中段，对于常规治疗后溃疡无明显好转的病例，要警惕食管克罗恩病、食管白塞病、嗜酸细胞性食管炎等特殊疾病。
[Abstract]:Objective to improve the understanding of benign esophageal ulcer and its etiology by analyzing the clinical characteristics of benign esophageal ulcer, so as to make early etiological diagnosis, timely treatment and improve prognosis. Methods the clinical data of 175 patients with benign esophageal ulcer diagnosed by gastroscopy in our hospital were analyzed retrospectively. Results from January 2010 to February 2014, 175 cases of benign esophageal ulcers were detected and pathologically confirmed by endoscopy in our hospital, including 124 males and 51 females, male: female 2.4: 1, age 1789 years, median age 64 years. 98 cases were caused by reflux esophagitis, followed by 47 cases with unknown cause, 26. 86%, 12 cases with esophageal injury, 8 cases with esophagus infection, 7 cases with inflammatory disease, 1 case with esophageal submucosal tumor and ulcer, 1 case with cardia loss retardation and 1 case with pemphigus. In the group of reflux esophagitis, 81 cases were over 50 years old and 81 cases were over 50 years old, while in the group of unknown cause, 34 cases of young adults were under 50 years old, the difference was significant (P 0.005). In this group, the digestive system symptoms were post-sternal discomfort, heartburn in 97 cases (55.43), followed by acid regurgitation, choking, dysphagia, epigastric pain, nausea, vomiting, hematemesis and hiccup. In the reflux esophagitis group, most of the endoscopic ulcers were located at the lower esophageal segment in 88 cases (89. 80%), and 63 cases (64. 2828%) had multiple ulcers. The ulcers were linear in shape, 71 cases in the stripe, and 72. 45 cases in the second, followed by irregular shape, round shape, circumferential shape and so on. In the group of unknown causes, 23 cases were located in the middle segment and 48.93 cases in the middle segment, and 33 cases in the single case, 70.21 cases. The ulcer was mainly round in 29 cases, followed by irregular shape, strip shape or longitudinal line. There was a significant difference in the distribution of ulcers between the two groups (P 0.005). The virus infection was mainly located in the middle segment of the esophagus in 3 cases, with multiple lesions in 4 cases, round or oval in 5 cases, and was similar to "volcanic ulcer" in 3 cases of esophageal Crohn's disease ulcers. There were 2 cases of multiple lesions with irregular shape, varying in size, with proliferative or protruding lesions around them. No typical granulomatous lesions were found in 3 cases of esophageal Behcet's disease 2 cases of middle segment single oval and round 1 case of lower segment multiple longitudinal esophagitis, 1 case of suspected eosinophilic esophagitis, and 1 case of lower segment single round type of esophagitis. Pathological findings showed that a large number of eosinophils infiltrating in 3 cases of drug-induced esophagitis were located in the middle of the esophagitis in 2 cases single, round and longitudinal in 1 case of multiple round. HP was detected in 138 cases (84.66%). In the reflux esophagitis group, 24 cases of hiatal hernia were associated with the disease, followed by 13 cases of peptic ulcer, diabetes mellitus, fungal esophagitis and so on. After routine treatment, 46 cases of reflux esophagitis were reviewed. 30 cases of reflux esophagitis were improved in 65.22 cases. 10 cases of reflux esophagitis, 10 cases of recurrence, 6 cases of progress, 3 cases of moderate atypical hyperplasia, 15 cases of unexplained cause, 3 cases of drug esophagitis, 5 cases of foreign body of esophagus, 3 cases of nonreflux esophagitis, 3 cases of reflux esophagitis, 5 cases of esophageal foreign body. One case of radiation esophagitis was treated with routine acid suppression, 3 cases with viral infection, 2 cases with esophageal Crohn's disease and 2 cases with esophageal Behcet's disease. One case of cardia apragalgia treated with calcium antagonist and one case of pemphigoid and one case of mucosal protection were improved after treatment of steroids and thalidomide respectively. Conclusion 1. Reflux esophagitis is the main cause of benign esophageal ulcer. Benign esophageal ulcers of unknown cause mostly occur in the young and adult, and their location is more common in the middle part of the esophagus. For those cases whose ulcers have not obviously improved after conventional treatment, it is necessary to guard against esophageal Crohn's disease and esophageal Behcet's disease. Eosinophilic esophagitis and other special diseases.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

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