Ménétriér病诊断和鉴别诊断.docVIP

Ménétriér病诊断和鉴别诊断 　　[摘要]目的：提高临床医生对Ménétriér病的诊断与鉴别诊断的能力。方法：回顾性分析我院收治并确诊的3例Ménétriér病病人的诊治经过，剖析误诊因素。结果：2例术前诊断错误，术后病理确诊；1例由协和医院确诊。Ménétriér病在黏膜征象、低蛋白血症和病理学改变三方面具有特征性改变，多次多点胃黏膜全层活检是确诊本病的关键。结论：临床医生通过加强对Ménétriér病的认识和提高相关的鉴别诊断的能力，能够早期地诊断和治疗该病。 　　[关键词]Ménétriér病；诊断；鉴别诊断；活检 　　[中图分类号]R573 [文献标识码]A [文章编号]1673-7210（2007）11（a）-036-02 　　 　　Diagnosis and differential diagnosis of Ménétriérs disease 　　HOU Ming-xing, LIU Bo,BAO Li-wei 　　(The First Affiliated Hospital of Inner Mongolia Medical College, Hohhot 010059, China) 　　[Abstract]Objective: To improve the doctors ability of diagnosis and differential diagnosis of Ménétriérs disease.Methods: The diagnosis and therapy process of the three cases in our hospital has been reviewed and analyzed, as well as the reasons for misdiagnosis. Results: Two of them were not correctly diagnosed untill the pathological report came back. And one case was diagnosed by Peking Union Medical College Hospital.Ménétriérs disease had characteristic changes in mucosal sign, hypoproteinemia and pathological changes. The key point of diagnosis correctly was to take more biopsies from multiple sites of gastric mucosa pucturely.Conclusion: The doctors should pay more attention to characteristic changes and differential diagnosis of Ménétriérs disease. 　　[Key words]Ménétriérs disease;Diagnosis; Differential diagnosis;Biopsy 　　 　　由于胃黏膜的过度增生而使胃壁广泛增厚肥大称为Ménétriér病，这一概念在1888由Ménétriér首次提出。1888～1977年世界有文献报道的该病仅有200例，而近20多年该病的报道例数又增加了近100例。本病发病缓慢、临床表现多种多样，临床误诊率很高。本文收集Ménétriér病3例，并综合分析其诊断过程中的误诊因素，以期提高临床医生对Ménétriér病的诊断与鉴别诊断的能力。 　　 　　1 资料与方法 　　 　　1.1年龄、性别和临床表现 　　发病年龄28～69岁，男性2例，女性 1例。病程1～3年，3例均有上腹钝痛、食欲明显下降、恶心偶有呕吐、全身乏力、水肿明显，3例均有低蛋白血症。1例有明显的黑便和恶病质改变，1例有反复间断发作的恶心、呕吐等类似幽门梗阻的表现，1例有反复发作的顽固性腹泻。 　　1.2诊断和治疗经过 　　有恶病质改变的病例经 CT检查显示：胃壁明显增厚，可见粗大的胃黏膜突向胃腔内，胃腔变小，考虑弥漫浸润型胃癌。行胃镜检查可见：粗大皱襞表面见浅溃疡及糜烂，表面色灰暗，胃壁僵硬，胃腔狭窄。取活检示：慢性炎症伴重度不典型增生。有幽门梗阻表现的病例胃镜显示：胃黏膜粗大以胃窦部最明显，黏膜表面粗糙、色灰暗，见糜烂和多发的浅表溃疡，质韧、蠕动差。取活检示：黏膜充血水肿，见大量淋巴细胞和浆细胞浸润，高度怀疑胃淋巴瘤。第1例术前诊断：Borrmann Ⅳ型胃癌，行剖腹探查、全胃切除术。术后病理：Méné