Matsuura H, Kuwano H, Kanematsu T, Sugimachi K, Haraguchi Y
Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Surg Oncol. 1990 Oct;45(2):79-84. doi: 10.1002/jso.2930450205.
We present here our findings on patients with an elevated lesion of the duodenal bulb. All these patients were treated in our clinics between the years 1984 and 1988. These lesions were present in 36 of 8,802 patients who underwent upper gastrointestinal pan-endoscopy. Two patients had a duodenal carcinoma, 2 an adenoma, and 1 a Brunner's gland adenoma. There were 15 with a hyperplastic polyp, 3 with a heterogenic gastric mucosa, 3 with Brunner's gland hyperplasia, 6 with duodenitis, and 4 with regenerative mucosa. Among these 36 lesions, only 69% (25 lesions) were evident on the upper gastrointestinal X-ray series. Adenoma and Brunner's gland adenoma were of a pedunculated form of the gross type and had an irregular surface mucosa. Both duodenal carcinomas were detected by endoscopic biopsy and were resected. Histologically, these lesions were limited to the submucosal layer and were of the non-pedunculated polypoid form, but there were no other characteristic endoscopic features, in comparison with other elevated lesions. Thus, upper gastrointestinal endoscopy with routine observations of the duodenal bulb plus endoscopic biopsy will lead to a definite diagnosis of these elevated lesions and to the early detection and treatment of this rare malignant lesion.
我们在此展示关于十二指肠球部隆起性病变患者的研究结果。所有这些患者均于1984年至1988年间在我们的诊所接受治疗。在8802例行上消化道全内镜检查的患者中，有36例存在此类病变。其中2例为十二指肠癌，2例为腺瘤，1例为布伦纳腺腺瘤。有15例为增生性息肉，3例为异质性胃黏膜，3例为布伦纳腺增生，6例为十二指肠炎症，4例为再生黏膜。在这36处病变中，在上消化道X线系列检查中仅69%（25处病变）显影。腺瘤和布伦纳腺腺瘤在大体类型上为有蒂型，表面黏膜不规则。两处十二指肠癌均通过内镜活检检出并进行了切除。组织学上，这些病变局限于黏膜下层，呈无蒂息肉样形态，但与其他隆起性病变相比，并无其他特征性内镜表现。因此，对上消化道进行十二指肠球部常规观察并结合内镜活检的内镜检查，将有助于对这些隆起性病变做出明确诊断，并早期发现和治疗这种罕见的恶性病变。
