84例胃双幽门荟萃分析
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摘要
目的双幽门是罕见的消化道疾病,可分为先天性和后天性两大类,以后天性多见。关于双幽门的文献多为案例报道,缺乏系统的认识。为了提高对双幽门的认识,对国内外文献报道的双幽门案例进行荟萃分析,以期对双幽门有较全面的认识,对临床实践有所帮助
方法以“双幽门”或“幽门重复”为检索词,检索中国知网,万方网络数据库,维普网络数据库1994～2010年发表的中文文献,以'double pylorus"或"pylorus duplication"为检索词,检索Pubmed和Web of Science1994～2010年发表的英文文献,收集并进行荟萃分析。
结果共有33篇中文文献和17篇英文文献共50篇报道84例病例入选。国内为43例,国外为41例,男59例(70.2%),女24例(28.6%),1例性别不详(1.2%),男女比例为2.46：1,具有极其显著差异(P＜0.01)。不同国籍的双幽门在不同性别的发生率没有显著差异(P＞0.05)。发病年龄最小为0.35岁,最大为88岁,平均年龄为59.99±17.72岁。不同国籍双幽门的平均年龄没有显著差异(P＞0.05)。不同性别之间双幽门的年龄均值没有显著差异(P＞0.05)。有58例病例报道中有症状描述,国内31例,国外38例,国内患者男性疼痛10例,出血症状9例,女性患者疼痛6例,出血6例,国外患者中国内患者男性疼痛17例,出血症状9例,梗阻症状2例,女性患者疼痛6例,出血3例,梗阻1例。国内和国外双幽门的症状构成没有显著差异(P＞0.05),男性和女性双幽门症状构成没有显著差异(P＞0.05)。共有26例病例行上消化道钡餐造影,确诊双幽门的病例中钡餐造影提示双幽门的有20例(76.9%),误诊或漏诊6例,分别如下：误诊为胃癌1例(3.8%),误诊为球部憩室1例(3.8%),误诊为胃炎2例(7.7%),提示正常(漏诊)2例(7.7%)。共有81例病例行胃镜检查,国内患者40例,单纯双幽门9例,双幽门伴溃疡29例,双幽门伴憩室及双幽门伴肿瘤各1例；国外患者41例,单纯双幽门30例,双幽门伴溃疡10例,双幽门伴肿瘤1例。国内患者中双幽门伴溃疡比例更高,和国外患者相比具有显著差异(P＜0.05)。在上消化道胃镜检查中,双幽门伴溃疡共39例,男性患者共29例,溃疡位置在胃窦的13(44.8%)例,十二指肠球部13(44.8%)例,复合溃疡1(3.4%)例,幽门管溃疡2(6.9%)例；女性患者共10例,溃疡位置在胃窦的5(50%)例,十二指肠球部3(30%)例,复合溃疡1(10%)例,幽门管溃疡1(10%)例。男性和女性之间溃疡位置没有显著差异(P＞0.05)。在胃镜检查中,双幽门伴溃疡其中有溃疡面积描述的共25例,溃疡面积均值为1.23±1.21cm2。男性患者共16例,溃疡面积均值为1.07±1.04cm2；女性患者共9例,溃疡面积均值为1.51±1.50cm2,男性和女性之间溃疡面积相比没有显著差异(P＞0.05)。
结论双幽门是临床少见的消化道疾病,男性多于女性,患者年龄分布在不同性别和不同国籍无明显差异。上消化道钡餐造影的诊断阳性率不高,确诊主要依靠胃镜检查。双幽门多伴发消化道溃疡,以胃窦和十二指肠多见,国内患者伴发消化道溃疡较国外患者多见。
Objective Double pylorus is a rare gastrointestinal disease. It can be congenital or acquired, most of which are acquired. The literatures on double pylorus are mostly case reports. To enhance realization of the disease, meta-analysis double pylorus reported in the literature.
Methods Using "double pylorus" or "pylorus duplicaiton" as key words, search "CNKI", "Wanfang network database", "Vip network database" for literature published in Chinese from 1994 to 2010. Use "double pylorus" or "pylorus duplicaiton" as key words, search Pubmed and Web of Science for literature published in English from 1994 to 2010. Then collect all the literatures and conduct meta-analysis.
Results 50 literatures have been collected, including 33 in Chinese and 17 in English.84 cases have been reported. For all 43 cases of domestic and the 41 patients for foreign, there are 59 male (70.2%) and 24 females (28.6%), one is unknown sex (1.2%). The ratio of male to female is 2.46:1(P< 0.01). Composition of double pylorus between different country or gender has no significantly difference (P> 0.05). Minimum age of onset was 0.35 years old and the maximum is 88 years old, mean age is 59.99±17.72. Between different country and age, there is no significant difference (P> 0.05). The age distribution of double pylorus between different genders has no significantly difference (P> 0.05).58 cases describe the symptoms,31 cases in domestic and 38 cases in abroad. Among 31 cases of chinese, there are 10 cases with pain,9 cases with bleeding for men, while 6 cases with pain and 6 cases with bleeding for women. For 31 cases of abroad, there are 17 cases with pain and 9 cases with bleeding and 2 cases with pyloric obstructive for men, while 6 cases with pain and 3 cases with bleeding and lcase with pyloric obstructive for women. There is no significant difference between different country and different gender for the symptoms constitute (P> 0.05). A total of 26 cases have barium meal, confirmed double pylorus by barium meal in 20 patients (76.9%), missed diagnosis or misdiagnosed are 6 patients(23.1%), misdiagnosed as gastric cancer in 1 case (3.8%), bulb diverticulum in 1 case (3.8%), gastritis in 2 cases (7.7%), indicating normal 2 cases (7.7%), which is missed diagnosis. A total of 81 cases have gastroscopy, 40 patients are Chinese, 9 cases have double pylorus alone, 29 cases have double pylorus with ulcer, lease with diverticulum and 1 case with cancer; 41 patients are abroad, 30 cases have double pylorus alone, 10 cases have double pylorus with ulcer, and 1 case with cancer. Chinese double pylorus with ulcer patients have a higher proportion compared with foreign patients with significantly difference (P<0.05). Within the 39 patients who has double pylorus with ulcer, male patients were 29 cases, ulcer location in the antrum 13 (44.8%) patients, duodenal 13 (44.8%) cases, complex ulcer 1 (3.4%) patient, pyloric ulcer 2 (6.9%) patients; female patients were 10 cases, ulcer location in the antrum 5 (50%) patients, duodenal 3 (30%) patients complex ulcer 1 (10%) case, pyloric ulcer 1 (10%) case. There is no significant difference between men and women of ulcer location (P> 0.05). The gastroscopy described ulcer area of the ulcer with double. The mean ulcer area is 1.23±1.21 cm2, and 16 cases of male patients is 1.07±1.04 cm2, while 9 female patients is 1.51±1.50 cm2. There is no significant difference between different genders of ulcer area (P> 0.05).
Conclusion Double pylorus is a rare digestive disease. It occurs in men more than women. The age distribution has no relationship with country and gender. The diagnostic positive rate of upper gastrointestinal barium meal was not high. Final diagnosis relies on gastroscopy. Double pylorus offen accompanied with gastrointestinal ulcers. The most common region is antrum and duodenum. Chinese have more double pylorus accompanied with peptic ulcer than abroad.
方法以“双幽门”或“幽门重复”为检索词,检索中国知网,万方网络数据库,维普网络数据库1994～2010年发表的中文文献,以'double pylorus"或"pylorus duplication"为检索词,检索Pubmed和Web of Science1994～2010年发表的英文文献,收集并进行荟萃分析。
结果共有33篇中文文献和17篇英文文献共50篇报道84例病例入选。国内为43例,国外为41例,男59例(70.2%),女24例(28.6%),1例性别不详(1.2%),男女比例为2.46：1,具有极其显著差异(P＜0.01)。不同国籍的双幽门在不同性别的发生率没有显著差异(P＞0.05)。发病年龄最小为0.35岁,最大为88岁,平均年龄为59.99±17.72岁。不同国籍双幽门的平均年龄没有显著差异(P＞0.05)。不同性别之间双幽门的年龄均值没有显著差异(P＞0.05)。有58例病例报道中有症状描述,国内31例,国外38例,国内患者男性疼痛10例,出血症状9例,女性患者疼痛6例,出血6例,国外患者中国内患者男性疼痛17例,出血症状9例,梗阻症状2例,女性患者疼痛6例,出血3例,梗阻1例。国内和国外双幽门的症状构成没有显著差异(P＞0.05),男性和女性双幽门症状构成没有显著差异(P＞0.05)。共有26例病例行上消化道钡餐造影,确诊双幽门的病例中钡餐造影提示双幽门的有20例(76.9%),误诊或漏诊6例,分别如下：误诊为胃癌1例(3.8%),误诊为球部憩室1例(3.8%),误诊为胃炎2例(7.7%),提示正常(漏诊)2例(7.7%)。共有81例病例行胃镜检查,国内患者40例,单纯双幽门9例,双幽门伴溃疡29例,双幽门伴憩室及双幽门伴肿瘤各1例；国外患者41例,单纯双幽门30例,双幽门伴溃疡10例,双幽门伴肿瘤1例。国内患者中双幽门伴溃疡比例更高,和国外患者相比具有显著差异(P＜0.05)。在上消化道胃镜检查中,双幽门伴溃疡共39例,男性患者共29例,溃疡位置在胃窦的13(44.8%)例,十二指肠球部13(44.8%)例,复合溃疡1(3.4%)例,幽门管溃疡2(6.9%)例；女性患者共10例,溃疡位置在胃窦的5(50%)例,十二指肠球部3(30%)例,复合溃疡1(10%)例,幽门管溃疡1(10%)例。男性和女性之间溃疡位置没有显著差异(P＞0.05)。在胃镜检查中,双幽门伴溃疡其中有溃疡面积描述的共25例,溃疡面积均值为1.23±1.21cm2。男性患者共16例,溃疡面积均值为1.07±1.04cm2；女性患者共9例,溃疡面积均值为1.51±1.50cm2,男性和女性之间溃疡面积相比没有显著差异(P＞0.05)。
结论双幽门是临床少见的消化道疾病,男性多于女性,患者年龄分布在不同性别和不同国籍无明显差异。上消化道钡餐造影的诊断阳性率不高,确诊主要依靠胃镜检查。双幽门多伴发消化道溃疡,以胃窦和十二指肠多见,国内患者伴发消化道溃疡较国外患者多见。
Objective Double pylorus is a rare gastrointestinal disease. It can be congenital or acquired, most of which are acquired. The literatures on double pylorus are mostly case reports. To enhance realization of the disease, meta-analysis double pylorus reported in the literature.
Methods Using "double pylorus" or "pylorus duplicaiton" as key words, search "CNKI", "Wanfang network database", "Vip network database" for literature published in Chinese from 1994 to 2010. Use "double pylorus" or "pylorus duplicaiton" as key words, search Pubmed and Web of Science for literature published in English from 1994 to 2010. Then collect all the literatures and conduct meta-analysis.
Results 50 literatures have been collected, including 33 in Chinese and 17 in English.84 cases have been reported. For all 43 cases of domestic and the 41 patients for foreign, there are 59 male (70.2%) and 24 females (28.6%), one is unknown sex (1.2%). The ratio of male to female is 2.46:1(P< 0.01). Composition of double pylorus between different country or gender has no significantly difference (P> 0.05). Minimum age of onset was 0.35 years old and the maximum is 88 years old, mean age is 59.99±17.72. Between different country and age, there is no significant difference (P> 0.05). The age distribution of double pylorus between different genders has no significantly difference (P> 0.05).58 cases describe the symptoms,31 cases in domestic and 38 cases in abroad. Among 31 cases of chinese, there are 10 cases with pain,9 cases with bleeding for men, while 6 cases with pain and 6 cases with bleeding for women. For 31 cases of abroad, there are 17 cases with pain and 9 cases with bleeding and 2 cases with pyloric obstructive for men, while 6 cases with pain and 3 cases with bleeding and lcase with pyloric obstructive for women. There is no significant difference between different country and different gender for the symptoms constitute (P> 0.05). A total of 26 cases have barium meal, confirmed double pylorus by barium meal in 20 patients (76.9%), missed diagnosis or misdiagnosed are 6 patients(23.1%), misdiagnosed as gastric cancer in 1 case (3.8%), bulb diverticulum in 1 case (3.8%), gastritis in 2 cases (7.7%), indicating normal 2 cases (7.7%), which is missed diagnosis. A total of 81 cases have gastroscopy, 40 patients are Chinese, 9 cases have double pylorus alone, 29 cases have double pylorus with ulcer, lease with diverticulum and 1 case with cancer; 41 patients are abroad, 30 cases have double pylorus alone, 10 cases have double pylorus with ulcer, and 1 case with cancer. Chinese double pylorus with ulcer patients have a higher proportion compared with foreign patients with significantly difference (P<0.05). Within the 39 patients who has double pylorus with ulcer, male patients were 29 cases, ulcer location in the antrum 13 (44.8%) patients, duodenal 13 (44.8%) cases, complex ulcer 1 (3.4%) patient, pyloric ulcer 2 (6.9%) patients; female patients were 10 cases, ulcer location in the antrum 5 (50%) patients, duodenal 3 (30%) patients complex ulcer 1 (10%) case, pyloric ulcer 1 (10%) case. There is no significant difference between men and women of ulcer location (P> 0.05). The gastroscopy described ulcer area of the ulcer with double. The mean ulcer area is 1.23±1.21 cm2, and 16 cases of male patients is 1.07±1.04 cm2, while 9 female patients is 1.51±1.50 cm2. There is no significant difference between different genders of ulcer area (P> 0.05).
Conclusion Double pylorus is a rare digestive disease. It occurs in men more than women. The age distribution has no relationship with country and gender. The diagnostic positive rate of upper gastrointestinal barium meal was not high. Final diagnosis relies on gastroscopy. Double pylorus offen accompanied with gastrointestinal ulcers. The most common region is antrum and duodenum. Chinese have more double pylorus accompanied with peptic ulcer than abroad.
引文
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[1]Hu T H, Tsai T L, Hsu C C, et al. Clinical characteristics of double pylorus.[J]. Gastrointest Endosc,2001,54(4):464-470.
[2]周丽雅.胃疾病[M].沈阳：辽宁科学出版社,2005.77-78.
[3]Einhorn R I, Grace N D, Banks P A. The clinical significance and natural history of the double pylorus. [J]. Dig Dis Sci,1984,29(3):213-218.
[4]Mylonas A, Papaziogas B, Paraskevas G, et al. Congenital double pyloric ostium in the adult.[J]. Surg Endosc,2002,16(11).
[5]陈文林.胃、十二指肠球癌伴双幽门形成的1例报告[J].江西医药,2003(05)：385.
[6]Matsuyama E, Nagashima R, Watanabe S, et al. Endoscopic hemostasis for hemorrhage from gastric cancer complicated by double-channel pylorus.[J]. Gastrointest Endosc,2001,53(6):679-680.
[7]Matsuyama E, Nagashima R, Watanabe S, et al. Endoscopic hemostasis for hemorrhage from gastric cancer complicated by double-channel pylorus[J]. Gastrointest Endosc,2001,53(6):679-680.
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[18]Almeida N, Romaozinho J M, Ferreira M, et al. Double pylorus with bleeding gastric ulcer-a rare event.[J]. Rev Esp Enferm Dig,2008,100(9):600-601.
[19]Sansone N, Schnall H A, Somnay K. Evolution of the pylorus from a double to a triple lumen.[J]. Gastrointest Endosc,2009,69(4):949,950.
[20]Sansone N S, Schnall H A, Somnay K. Evolution of the pylorus from a double to a triple lumen[J]. American Journal Of Gastroenterology,2006,101Suppl. S(9):661.
[21]Ehrhardt D, Lohr M, Liebe S. Double pylorus as a cause of gastrointestinal bleeding.[J]. J R Soc Med,1999,92(5):253-254.
[22]Kothandaraman K R, Kutty K P, Hawken K A, et al. Double pylorus--in evolution. [J]. J Clin Gastroenterol,1983,5(4):335-338.
[23]Hegedus V, Poulsen P E, Reichardt J. The natural history of the double pylorus.[J]. Radiology,1978,126(1):29-34.
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[25]Hunt R H, Day R C, Jewell D P. Acquired double pylorus.[J]. Br Med J,1978,1(6115):759.
[26]Akazawa Y, Mizuta Y, Osabe M, et al. A case of double pylorus caused by recurrent gastric ulcers: A long-term endoscopic observation[J]. Dig Dis Sci,2005,50(11):2125-2128.
[27]Akazawa Y, Mizuta Y, Osabe M, et al. A case of double pylorus caused by recurrent gastric ulcers:a long-term endoscopic observation.[J]. Dig Dis Sci,2005,50(11):2125-2128.
[28]吴勇,李高喆,刘晓梅,等.胃重复双幽门畸形合并溃疡出血1例分析[J].中国误诊学杂志,2007(14)：3420-3421.
[29]沈顺华,毛登明,李昌平,等.双幽门畸形并溃疡出血1例[J].泸州医学院学报,2002(03)：202.
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[26]Sansone N, Schnall H A, Somnay K. Evolution of the pylorus from a double to a triple lumen.[J]. Gastrointest Endosc,2009,69(4):949,950.
[27]Sansone N S, Schnall H A, Somnay K. Evolution of the pylorus from a double to a triple lumen[J]. American Journal Of Gastroenterology,2006,101Suppl. S(9):661.
[28]Ehrhardt D, Lohr M, Liebe S. Double pylorus as a cause of gastrointestinal bleeding.[J]. J R Soc Med,1999,92(5):253-254.
[29]Kothandaraman K R, Kutty K P, Hawken K A, et al. Double pylorus--in evolution. [J]. J Clin Gastroenterol,1983,5(4):335-338.
[30]Hegedus V, Poulsen P E, Reichardt J. The natural history of the double pylorus.[J]. Radiology,1978,126(1):29-34.
[31]Graham S M, Lin F, Flowers J L. Symptomatic double-channel pylorus. Successful treatment with a biliary sphincterotome.[J]. Surg Endosc,1994,8(7):792-793.
[32]Hunt R H, Day R C, Jewell D P. Acquired double pylorus.[J]. Br Med J,1978,1(6115):759.
[33]Akazawa Y, Mizuta Y, Osabe M, et al. A case of double pylorus caused by recurrent gastric ulcers:A long-term endoscopic observation[J]. Dig Dis Sci,2005,50(11):2125-2128.
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[35]吴勇,李高喆,刘晓梅,等.胃重复双幽门畸形合并溃疡出血1例分析[J].中国误诊学杂志,2007(14)：3420-3421.
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[41]Mcgrew W, Spear M, Sutton W, et al. Acquired double pylorus. [J]. South Med J,1984,77(9):1167-1170.
[42]Hu T H, Tai D I, Changchien C S, et al. Double pylorus:report of a longitudinal follow-up in two refractory cases with underlying diseases.[J]. Am J Gastroenterol,1995,90(5):815-818.
[43]Fayenz S. The evolution of the double pylorus.[J]. Gastrointest Endosc,1986,32(1):31-32.
[44]Polloni A, Marchi S, Bellini M, et al. Double pylorus:report of two cases and review of the literature. [J]. Ital J Gastroenterol,1991,23(6):360-363.
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[46]Bennike S, Hegedus V. The double pylorus.[J]. Br J Radiol,1976,49(577):90-92.
[47]Yoshimura Y, Yasutake K, Imamura Y, et al. Double pylorus accompanied by gastric ulcer resistant to H2-receptor antagonist--a case report and review of the literature.[J]. Kobe J Med Sci,1988,34(4):151-159.
[48]Tseng C W, Tsai J J, Lin H J. Double pylorus:an unusual complication of peptic ulcer disease (with video).[J]. Clin Gastroenterol Hepatol,2008,6(10):e38.
[49]Chiu H H, Jao Y T, Mo L R. Double pylorus.[J]. Gastrointest Endosc,2002,56(2):271.
[50]Cipolletta L B M R G. Prospective comparison of argon plasma coagulator and heater probe in the endoscopic treatment of major peptic ulcer bleeding[J]. Gastrointest Endoscopy,1998,48:191-195.
[1]Hu T H, Tsai T L, Hsu C C, et al. Clinical characteristics of double pylorus.[J]. Gastrointest Endosc,2001,54(4):464-470.
[2]周丽雅.胃疾病[M].沈阳：辽宁科学出版社,2005.77-78.
[3]Einhorn R I, Grace N D, Banks P A. The clinical significance and natural history of the double pylorus. [J]. Dig Dis Sci,1984,29(3):213-218.
[4]Mylonas A, Papaziogas B, Paraskevas G, et al. Congenital double pyloric ostium in the adult.[J]. Surg Endosc,2002,16(11).
[5]陈文林.胃、十二指肠球癌伴双幽门形成的1例报告[J].江西医药,2003(05)：385.
[6]Matsuyama E, Nagashima R, Watanabe S, et al. Endoscopic hemostasis for hemorrhage from gastric cancer complicated by double-channel pylorus.[J]. Gastrointest Endosc,2001,53(6):679-680.
[7]Matsuyama E, Nagashima R, Watanabe S, et al. Endoscopic hemostasis for hemorrhage from gastric cancer complicated by double-channel pylorus[J]. Gastrointest Endosc,2001,53(6):679-680.
[8]Friehling J S, Rosenthal L E. Gastric carcinoma presenting as double-channel pylorus on upper gastrointestinal series.[J]. Dig Dis Sci,1985,30(3):269-273.
[9]Fine M, Kavin H, Grant T. Double channel pylorus as a complication of carcinoma of the stomach.[J]. Gastrointest Endosc,1987,33(1):39-41.
[10]刘晶晶.双幽门畸形合并十二指肠球部腺癌一例[J].临床内科杂志,2009,26(10)：699.
[11]邓平.先天性双幽门两例报告[J].白求恩医科大学学报,1995(05)：507.
[12]Wiseman S M, Tan D, Hill H C. Double pylorus:an unusual endoscopic finding.[J]. Endoscopy,2005,37(3):277.
[13]Eshchar J, Segal R, Brauman A. Double pylorus or antro-bulbar fistula.[J]. Int J Tissue React,1984,6(1):97-100.
[14]Williams R S, Gilmore I T, Johnson A G. Congenital double pylorus:a case report.[J]. Br J Surg,1981,68(1):65.
[15]Wolters V M, Nikkels P G, Van Der Zee D C, et al. A gastric diverticulum containing pancreatic tissue and presenting as congenital double pylorus: case report and review of the literature. [J]. J Pediatr Gastroenterol Nutr,2001,33(1):89-91.
[16]Stannard M W, Currarino G, Splawski J B. Congenital double pylorus with accessory pyloric channel communicating with an intraluminal duplication cyst of the duodenum.[J]. Pediatr Radiol,1993,23(1):48-50.
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