Gerl A, Storck M, Schalhorn A, Müller-Höcker J, Jauch K W, Schildberg F W, Wilmanns W
Department of Medicine III, LM University Munich, West Germany.
Gut. 1992 Jul;33(7):1000-3. doi: 10.1136/gut.33.7.1000.
This report describes paraneoplastic visceral neuropathy including achalasia, gastroparesis, subileus and constipation in a 59 year old patient with metastasising atypical bronchial carcinoid. Achalasia was successfully treated by cardiomyotomy and fundoplication; additionally, extramucosal pylorectomy was undertaken to improve gastric emptying. Endoscopic papillotomy was necessary because of a functional stenosis of the sphincter of Oddi with development of obstructive jaundice. Symptoms of intestinal pseudoobstruction did not improve with cisapride or corticosteroid treatment. Histological examination of gastrointestinal specimens revealed a lymphocytic infiltration of the myenteric plexus associated with loss of neurones. The rheumatoid factor was positive, there was evidence of circulating immune complexes and antibodies to Sm-antigen were present, suggesting a possible autoimmune pathogenesis.
本报告描述了一名59岁转移性非典型支气管类癌患者的副肿瘤性内脏神经病变，包括贲门失弛缓症、胃轻瘫、亚肠梗阻和便秘。贲门失弛缓症通过贲门肌切开术和胃底折叠术成功治疗；此外，还进行了黏膜外幽门切除术以改善胃排空。由于Oddi括约肌功能性狭窄并发展为梗阻性黄疸，因此需要进行内镜下乳头切开术。西沙必利或皮质类固醇治疗未能改善肠道假性梗阻症状。胃肠道标本的组织学检查显示肌间神经丛有淋巴细胞浸润，并伴有神经元丢失。类风湿因子呈阳性，有循环免疫复合物的证据，且存在抗Sm抗原抗体，提示可能存在自身免疫性发病机制。
