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胃毛霉菌病临床上罕见,极易误诊,近来我们发现2例,现报告如下。 例1 男性,41岁,农民。因反复右上腹痛8年,腹部肿块4年,消瘦1个月,于1998年3月5日入院。查体:T37℃,P80次/分,R 20次/分,BP 15/10kPa(112/75mmHg),意识清,消瘦,浅表淋巴结未触及,心肺无异常,右上腹饱满,可触及一约3cm×4cm肿块,有压痛,质中,无波动感,胃振水音阳性,移动性浊音阴性。胃镜检查:入镜65cm,见胃窦狭小畸形,其大弯侧有一3cm×3cm不规则状隆起病变,表面粗糙,质地硬,蠕动消失;小弯、前壁、后壁见数处浅溃疡,表面披白苔;幽门孔圆,舒缩欠佳,球部粘膜光滑;伴假幽门形成。病理报告示:胃毛霉菌病。因临床仍高度怀疑胃癌,于3月18日行剖腹探查,术中见幽门部5cm×6cm大小质硬肿块,包裹肝十二指肠韧带,快速冰冻切片示慢性溃疡伴毛霉菌感染,因分离门静脉与胆总管困难,只行胃—空肠侧侧吻合术,术后病情平稳,半月出院。术后病理切片:慢性溃疡穿孔伴毛霉菌感染。
Gastric mucormycosis is clinically rare, easily misdiagnosed, and recently we found 2 cases, are as follows. Example 1 Male, 41 years old, farmer. Due to repeated right upper quadrant pain 8 years, abdomen mass 4 years, weight loss 1 month, on March 5, 1998 admitted. Examination: T37 ℃, P80 beats / min, R 20 beats / min BP 15 / 10kPa (112 / 75mmHg), clear consciousness, weight loss, superficial lymph nodes not touched, no abnormal heart and lung, right upper quadrant full, 3cm × 4cm mass, tenderness, quality, no sense of volatility, stomach vibration sound positive, voiced negative mobility. Gastroscopy: Into the mirror 65cm, see the antrum of small deformities, the large curved side has a 3cm × 3cm irregular bulge lesions, the surface roughness, texture hard, peristalsis disappeared; small bends, the anterior wall, Phlox surface covered; pyloric hole round, shrinkage and poor, the Ministry of mucosa smooth; with the formation of false pylorus. Pathology report shows: gastric mucormycosis. Because of clinical suspicion of gastric cancer is still high, on March 18 laparotomy exploration, intraoperative see pylorus 5cm × 6cm size hard mass, wrapped the hepatoduodenal ligament, rapid frozen section showed chronic ulcer with Mucormycosis, due to separation Portal venous and common bile duct difficult, only the side of the stomach - jejunum anastomosis, postoperative stable condition, half discharged. Postoperative pathology: Chronic ulcer perforation with Mucormycosis.