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9、硕士,住院医师,研究方向:消化系统疾病诊治。E-mail:2213276605 通讯作者:李莉,博士,主任医师,副教授,硕士生导师,研究方向:消化肿瘤的发病机制与临床诊疗。E-mail:lily9711214 doi:10.3969/j.issn.1006-5709.2023.01.015个案报道联合胃镜及病理诊断先天性短食管 1 例报道阚倩1,李莉21.徐州医科大学第一临床医学院,江苏 徐州 221002;2.徐州医科大学附属医院消化内科【摘要】本文报道 1 例联合胃镜及病理诊断先天性短食管合并胃溃疡患者,其就诊时主要表现为腹痛、腹胀,门诊胃镜检查提示食管占位可能,入院后予以复查胃镜发现齿状
10、线上移及胃溃疡,多处取活检证实短食管,影像学检查提示胸腔胃,诊断为先天性短食管合并胃溃疡。【关键词】先天性短食管;胃溃疡;胸腔胃;胃镜;病理中图分类号:R571文献标识码:B文章编号:1006-5709(2023)01-0070-02收稿日期:2022-01-29Congenital short esophagus diagnosed by gastroscopy and pathology:one case reportKAN Qian1,LI Li21.First Clinical Medical College,Xuzhou Medical University,Xuzhou 22100
11、2;2.Department of Gastroenterology,the Affiliated Hospital of Xuzhou Medical University,China【Abstract】This article reported a case of congenital short esophagus with gastric ulcer diagnosed by gastroscopy and pathology,the main symptoms of the patient were abdominal pain and abdominal distension,an
12、d the outpatient gastroscopy suggested the possibility of esophageal space-occupying lesions.Reexamination of gastroscopy after admission showed that the dentate line moved up and gastric ulcer was found,short esophagus was confirmed by multiple biopsies,imaging examination suggested intrathoracic s
13、tomach,then diagnosed of congenital short esophagus with gastric ulcer.【Key words】Congenital short esophagus;Gastric ulcer;Intrathoracic stomach;Gastroscope;Pathology07胃肠病学和肝病学杂志2023 年 1 月第 32 卷第 1 期Chin J Gastroenterol Hepatol,Jan 2023,Vol.32,No.1病例患者,女,82 岁,因“腹痛、腹胀 1 个月余”于 2020年 12 月 16 日入住我院,患者 1
14、 个月前无明显诱因出现腹痛、腹胀,以上腹部为主,伴后背部及肋间隙牵涉痛,无发热、咳嗽,无胸闷、心悸,无反酸、烧心,无恶心、呕吐,至我院门诊行胃镜检查(2020-12-15)示:(1)食管占位(Ca?)(见图 1A);(2)食管裂孔疝(见图 1B);(3)慢性浅表性胃炎伴糜烂(见图 1C)。于胃镜下距门齿约 32 cm 处取活检(见图 1A),病理示慢性浅表性胃炎(见图 2),提示胃镜下距门齿约 32 cm 处为胃黏膜。患者既往因胆囊结石行胆囊切除术,手术顺利,其余病史无特殊。入院后体格检查未见明显阳性体征;实验室检查示 CA199 52.22 U/ml和 CA50 60.09 IU/ml,血常
15、规、肝肾功能、电解质等均未示明显异常。胸腹部 CT(2020-12-18)提示胸腔胃(见图 3)。2020 年12 月 21 日予以复查胃镜,镜下食管黏膜形态未见异常,贲门结构消失,齿状线清晰(见图 4A),齿状线距门齿约 20 cm,齿状线以下见胃黏膜环绕管腔(见图 4B),距门齿约 32 cm 见对吻溃疡形成(见图 4C)。为进一步明确溃疡性质及确定齿状线位置,分别于胃镜下距门齿约 20 cm 黏膜(见图 4A)、26 cm 黏膜(见图 4B)及 32 cm 溃疡(见图 4C)处取活检,病理(2020-12-21)示:距门齿 20 cm 为部分鳞状上皮及黏液柱状上皮(见图5A),提示此处为
16、齿状线位置;距门齿 26 cm(见图 5B)及距门齿 32 cm(见图 5C)均提示为胃黏膜。该患者食管黏膜形态未见明显异常,临床未发现导致患者食管短小的获得性因素,因此诊断为:(1)先天性短食管伴胸腔胃;(2)胃溃疡,予以保守治疗后患者症状减轻。注:A:距门齿约 32 cm 见不规则溃疡,表覆污苔,活检质韧;B:贲门舒张差,充气后显示不清,倒镜可见疝囊;C:胃体及胃窦黏膜充血、水肿,散在糜烂灶。图 1胃镜检查结果(2020-12-15)Fig 1Result of gastroscopy(2020-12-15)注:图 2 为(食管)送检胃黏膜示浅表黏膜慢性炎,中度活动性,伴腺体中度肠化(HE 染色,放大 100 倍);图 3 为食管扩张积液(后经证实为胸腔胃),胃体大弯侧壁不规则增厚,周围示多发稍大淋巴结影,膈肌上方示胃影。图 2病理结果(距门齿约 32 cm)(2020-12-15);图 3胸腹部 CT(2020-12-18)Fig 2Result of pathology(about 32 cm from the incisor)(2020-12-15);Fig 3Chest a
