發(fā)布時間：2018-06-02 03:18

  本文選題：良性食管潰瘍 + 病因��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的通過良性食管潰瘍臨床特點的分析，提高對該病及其病因的認識，做到早期病因診斷、及時治療、改善預后。 方法回顧性分析了我院經胃鏡確診的175例良性食管潰瘍患者的臨床資料。 結果我院內鏡室2010年1月至2014年2月經胃鏡下檢出及病理證實為良性食管潰瘍175例，男性124例，女性51例，男：女=2.4：1；年齡范圍17~89歲，中位年齡64歲。反流性食管炎所致為主（98例，56%），其次為不明原因（47例，26.86%），食管損傷12例，食管感染8例，炎癥性疾病7例，食管黏膜下腫物合并潰瘍、賁門失遲緩癥、天皰瘡各1例。反流性食管炎組以中老年人多見，50歲以上者81例（82.65%），不明原因組，青壯年居多，50歲以下者34例（72.33%），差異有顯著統(tǒng)計學意義（P0.005）。本組患者消化系統(tǒng)癥狀以胸骨后不適、燒心為主（97例，55.43%），其次為反酸、進食梗噎感、吞咽疼痛、吞咽困難、上腹痛、惡心、嘔吐、嘔血和呃逆等。反流性食管炎組內鏡下潰瘍多局限于食管下段（88例，89.80%），多發(fā)為主（63例，64.28%），潰瘍形態(tài)以線狀、條狀多見（71例，72.45%），其次為不規(guī)則形、類圓形、環(huán)周形等；不明原因組以中段多見（23例，48.93%），多單發(fā)（33例，70.21%），潰瘍形態(tài)以類圓形為主（29例，61.70%），其次為不規(guī)則形，條形或縱行等。兩組潰瘍的分布，差異有顯著意義（P0.005）。6例病毒感染多位于中段（3例），多發(fā)為主（4例），類圓形或橢圓形（5例），均似“火山潰瘍”；3例食管克羅恩病潰瘍中下段為主，多發(fā)（2例），形態(tài)不規(guī)則，大小不等，周邊有增生或隆起病變，病理未見典型肉芽腫病變；3例食管白塞病，2例中段單發(fā)橢圓形和類圓形，1例下段多發(fā)縱行；1例可疑嗜酸細胞性食管炎，下段單發(fā)類圓形，病理見大量嗜酸性粒細胞浸潤；3例藥物性食管炎均位于中段，2例單發(fā)，類圓形和縱行，1例多發(fā)，4處類圓形。Hp檢測陽性138例，占84.66%。反流性食管炎組主要伴發(fā)疾病為食管裂孔疝（24例），其次為消化性潰瘍（13例）、糖尿病、霉菌性食管炎等。反流性食管炎常規(guī)治療后復查46例，30例好轉（65.22%），，10例反復，6例進展（3例Barrett，s食管，3例中度不典型增生）；非反流性食管炎復查的不明原因15例，藥物性食管炎3例，食管異物5例，放射性食管炎1例常規(guī)抑酸、保護黏膜治療后潰瘍愈合，3例病毒感染，抗病毒及常規(guī)治療后好轉，2例食管克羅恩病激素治療后好轉，2例食管白塞病，分別激素和沙利度胺治療后好轉，1例賁門失遲緩癥鈣離子拮抗劑及保護黏膜治療后好轉，1例天皰瘡激素及保護黏膜治療后好轉。 結論1.反流性食管炎是引起良性食管潰瘍的主要原因；2.不明原因良性食管潰瘍多發(fā)生于青壯年，其發(fā)生部位多見于食管中段，對于常規(guī)治療后潰瘍無明顯好轉的病例，要警惕食管克羅恩病、食管白塞病、嗜酸細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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R571

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本文編號：1967117