Laucevicius V L, Norkunas P, Razukas V, Jurevicius B, Misevicius I, Noreika L
Z Gesamte Inn Med. 1976 Jun 1;31(11):386-9.
The fibrogastroscopic and gastrobioptic examination of 101 patients after acute intoxication with corrosive substances (vinegar essence, sulphuric acid, hydrochloric acid, lyes a. o.) revealed in all cases a chemical erosion of the gastric mucous membrane of different degree, also in such a case, where there existed neither clinical nor radiological symptoms of the corrosive gastritis. Endoscopically the erosions of the mucous membrane were classified into three degrees of severity: Insignificant erosions were characterized by reddening and swelling of the mucous membrane, foamy phlegm and fluid, medium erosions by numerous puncti-form erosions on the hyperaemic oedematous mucous membrane covered with fibrin, severe erosions, finally, by haemorrhages and dark-gray necrotic areas. Pathohistologically in easy erosions were found a serous or catarrhalic-serous inflammation on the 1st to 5th day, a transition of proliferative processes in regenerative ones on the 6st to 10th day and a complete reparative regeneration on the 11th to 20th day. In medium erosion there existed a catarrhalic or catarrhalic-fibrinous inflammation with erosions on the 1st to 10th day; the regeneration of the mucous membrane took place on the 21st to 30th day. Severe erosions were characterized by a phlegmonous-ulcerous or ulcerous-necrotic inflammation between the 16th and 30th day and the reparative-fibrotic transformation of the mucous membrane between the 31st to the 60th day. After severe erosion no restitution ad integrim took place. There developed either a chronic atrophic gastritis or, when an excessive cicatrisation is present, a stenosis of the prepylorus. A control of the patients including endoscopic examinations which are performed to 6 months after easy erosion, up to one year after medium erosion and up to 5 years after severe erosion, is of importance for the estimation of course, therapy and prognosis.
对101例腐蚀性物质(如醋酸、硫酸、盐酸、碱液等)急性中毒患者进行的纤维胃镜和胃活检检查发现,所有病例均存在不同程度的胃黏膜化学性侵蚀,即使在没有腐蚀性胃炎临床及放射学症状的情况下亦是如此。在内镜下,黏膜侵蚀分为三个严重程度等级:轻度侵蚀的特征为黏膜发红、肿胀、有泡沫状黏液和液体;中度侵蚀表现为充血水肿的黏膜上有许多点状侵蚀,覆盖有纤维蛋白;重度侵蚀则表现为出血和深灰色坏死区域。病理组织学检查显示,轻度侵蚀在第1至5天为浆液性或卡他性 - 浆液性炎症,第6至10天增殖过程向再生过程转变,第11至20天完全修复性再生。中度侵蚀在第1至10天为卡他性或卡他性 - 纤维蛋白性炎症伴侵蚀,黏膜再生在第21至30天发生。重度侵蚀在第16至30天为蜂窝织炎性 - 溃疡性或溃疡性 - 坏死性炎症,第31至60天黏膜发生修复性 - 纤维化转变。重度侵蚀后无法完全恢复原状。要么发展为慢性萎缩性胃炎,要么在瘢痕形成过度时出现幽门管狭窄。对患者进行随访,包括在轻度侵蚀后6个月、中度侵蚀后1年、重度侵蚀后5年进行内镜检查,对于评估病程、治疗和预后非常重要。