消化道重复畸形医学PPT.ppt

Duplicationofthealimentarytract Duplicationofthealimentarytractareraresphericalortubularstructureswhichcanoccuranywhereinthetractfrommouthtoanus Someoftheanomalieswerealsocalled enterogenouscysts Introduction Embryology TheetiologyofGIduplicationshasstillnotbeenestablished Severaltheoryabouttheoccurrenceofduplication recanalizationfailuretheorysplitnotochordtheoryabnormalbloodsupplytheory 囊肿型 Pathology 管状型 Pathology Pathology Duplicationsarehollowstructurethatinvolvethesideoftheassociatedgastrointestinal GI tract Theytendtoshareacommonmuscularwallandbloodsupplywithitsmaturebowel althougheachhasitsownseparatelining Duplicationscontaininggastricmucosaareatriskofpepticulceration perforationandhaemorrhage PatchesofectopicgastricmucosaalongtheGItractmayrepresentthemildestmanifestationofduplicationabnormalities Ectopicpancreatictissuehasbeenreportedinduplicationsofthestomach ileumandcolon Pathology Thecontentsofaduplicationvarywiththetypeofepithelialliningofthestructure thepresenceorabsenceofacommunicationwiththeproximatepartoftheGItractandtheabsenceornecrosisoftheduplicationwall Pathology Esophagealduplication Gastricduplication ClincalexpressionLesscommon accountfor3 8 ofallGIduplication 60 foundinthe1styearoflife 40 appearinneonatalperiodPalpaplecysticmassintheupperabdomenaccompaniedbyvomitingandweightlossRarelyundergopepticulceration haematesisandmelaenaOftendifficulttomakeapreoperativediagnosis Bariummeal compressionofthestomach usuallyalongthegreatercurvature oracommunicationbetweenthestomachandtheduplicationAnothercyst esp esophagealcystmayalsoexists Gastricduplication RareVomiting weightlossandapalpableabdominalmassarethemainfindings X rayfindings signsofgastricoutletorduodenalobstructionwithalackofdistalbowelgas Gastricduplication Treatment surgicalexcisionoftheduplication Pyloricduplication Duodenalduplication 5 6 ofallduplicationsOftenbehindtheduodenumanddonotcommunicatewiththebowellumenVomitingduetopartialorcompleteduodenalobstruction haematemesis perforationUpperabdominalmassBariummealshowscompressionoftheduodenumUltrasonographyshowscystlesionbelowtheliver TreatmentExcisionoftheduplicationCystoduodenostomyStrippingofftheliningmucosaandleavingthatpartofthecystwhichisadherenttotheduodenumorpancerase Duodenalduplication Duplicationofthesmallintestine 45 ofallalimentaryduplicationCystsatterminalileummostcommonAlwaysexistatthemesentericsideClinicalmanifestation obstruction abodominalmass haemorrhage peritonitisandothersPancreaticandgastricmucosamaypresentintubularduplications whichcanbefoundwithTc 99misotopescanning 腹腔内边界清楚的厚壁囊性肿物 圆形 椭圆形或不规则形 内呈无回声 与肠管关系密切 囊肿型ATD 主要表现为腹腔囊性肿物 管状型ATD 腹腔内异常走向的不规则形囊肿 腹部CT囊肿型ATD在CT上多表现为腹腔内与肠管关系密切的囊状 单房 厚壁的低密度肿物 大多边界清楚 圆形或椭圆形 管型重复畸形及少数囊肿型重复畸形囊性结构的形状可不规则 增强扫描可见囊壁强化 但囊内容物无增强 若与正常肠道相通 囊肿内可出现气体影 合并肠梗阻时伴肠管扩张 由于管状ATD走行迂曲 在不同层面上可显示2个甚至多个单房囊腔影的层面 TreatmentForcysticduplication resectionofthecystwithadjacentbowelForlongtubularduplications 1 Coringoutthemucosalliningofalongtubularduplicationthroughmultipleseromuscularincisionsinthewalloftheduplication2 anastomosingthedistalendoftheduplicationtoadjacentnormalintestine allowingfreedrainageofthecontents Smallbowelduplication Colonicduplication Rare16 30 ConstipationorobstructionBariumenemamaydemonstrateacommunicationoracompressionAssociatedgenitourinaryandlumbosacralspineabnormalitiesshouldbenoticed Colonicduplication Treatment Thepricipleaimistoendupwithtwocolonsdrainingthroughoneanalorifice Rectalduplications Presentationofthecystsdependon a sizeb fistulac infectiond ulceratione malignancy Rectalduplication Treatment surgicalexcisionAtransanalortranscoccygealapproachcanbeemployed Meckel sDiverticulum Thefirstknowndescriptionofthisdiseasewasin1598byHildanus Meckel sDiverticulum ResultsfromfailureoftheproximalducttoobliterateAbnormalregressionofthevitellineductcanberesultin cysts fibrousbanslinkingtheintestinetotheabdominalwall umbilicalsinuses completepersistenceasanomphloilealfistu