* ﺝ
دﺎـﺘﺳا ﻲﺣاﺮﺟ هوﺮﮔ رﺎﻳ لﺎﻔﻃا
هﺎﮕﺸﻧاد ، ﻲﻜﺷﺰﭘ مﻮـﻠﻋ ﻛ
ﺎ ﺎﺷ ن ، نﺎﺘﺳرﺎﻤﻴﺑ لﺎﻔﻃا ﻲﺣاﺮﺟ ﺶﺨﺑ ،نﺎﺷﺎﻛ ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻮـﮕﺨﺳﺎﭘ ةﺪﻨﺴﻳﻮﻧ
: ﺮﺘﻛد يدﺮـﻤﻧاﻮﺟ ﺪﻤﺤﻣ
د**
ﺘﺳ ﻴـ ﻲﺣاﺮﺟ هوﺮﮔ رﺎ ﻲﻣﻮﻤﻋ
هﺎﮕﺸﻧاد ، ﻲﻜﺷﺰﭘ مﻮـﻠﻋ ﻛ
ﺎ ﺎﺷ ن ، نﺎﺘﺳرﺎﻤﻴﺑ نﺎﺷﺎﻛ ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ ﻦﻔﻠﺗ
: 88367368
،ﻲﻜﺷﺰﭘ يﻮﺠﺸﻧاد***
هﺎﮕﺸﻧاد ﻲﻜﺷﺰﭘ مﻮﻠﻋ نﺎﺷﺎﻛ
Email: [email protected]
لﻮﺻو ﺦﻳرﺎﺗ : 17 / 10 / 1385
شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
21 / 01 / 1386
هﺪﻌﻣ زﻮﭙﻴﻟﻮﭘ ﺐﻟﺎﺟ درﻮﻣ ﻚﻳ ﻲﻓﺮﻌﻣ
ﻲﻜﺷﺰﭘ ﻊﺑﺎﻨﻣ ﺮﺑ يروﺮﻣ و درﻮﻣ ﻚﻳ شراﺰﮔ
ﺮﺘﻛد ﻤﻧاﻮﺟ ﺪﻤﺤﻣ ـ
*
يدﺮ ﺮﺘﻛد ، ﻘﻧ ﻪﻴﺿﺮﻣ ـ
يﻮ يﺪﻧوار ،
**ﻴﻣ ﻪﻬﻟا ـ ﻪﻧﺎ
***
زﺎﺳ
ﻭ ﻩﮊﺍ ﻱﺪﻴﻠﻛ ﻱﺎﻫ :
ﻲﻤﻧﺁ ،ﮏﻴﺘﺳﻼﭘﺮـﭙﻴﻫ ﭗـﻴﻟﻮﭘ ،ﻩﺪﻌﻣ ﺯﻮـﭙﻴﻟﻮﭘ
ﻨﻴﻣز ﻪ فﺪﻫ و
ﻮﭘ ،هﺪــﻌﻣ ﻢﻴــﺧ شﻮــﺧ يﺎــﻫرﻮﻣﻮﺗ ﻦﻳﺮﺘﻌﻳﺎــﺷ ﭗــﻴﻟ
يﺎــﻫ
ﻲﭘا
ﭗـﻴﻟﻮﭘ ﻞﻣﺎـﺷ ﻪـﻛ ﺪﻨﺘﺴﻫ ﻲﻳﺎﻴﻠﺗ
ﻚﻴﺘـﺳﻼﭘ ﺮـﭙﻴﻫ يﺎـﻫ
) ﻮــﻴﺗاﺮﻧژر (
، ﻚــﻴﭘﻮﺗوﺮﺘﻫ ،زﻮﺗﺎــﻣﻮﺗرﺎﻣﺎﻫ ،ﻲﺑﺎــﻬﺘﻟا ،زﻮﺗﺎــﻣﻮﻧدآ
ﻲﻣ ﺪﻨﺷﺎﺑ
1. ﭗﻴﻟﻮﭘ ﻦﻳا عﻮﻴﺷ ﻲـﺘﻠﻋ ﺮـﻫ ﻪـﺑ ﻪـﻛ يداﺮـﻓا رد ﺎﻫ
آ ﻲﻣ مﺎﺠﻧا ﻲﭘﻮﻜﺳوﺪﻧ ﺪﻨﻫد
، 2 / 1 ﻲﻣ ﺪﺻرد ﺪـﺷﺎﺑ
2. ﻲﻧارﺎـﻤﻴﺑ رد
ًﻼﺒﻗ ﻪﻛ هﺪﻌﻣ ﻲﺣاﺮﺟ )
ﻮﺗ بﺎﺳ ﻪﻠﻤﺟ زا ﻲﻣﻮﺘﻛﺮﺘﺳﺎﮔ لﺎﺗ
( مﺎـﺠﻧا
هداد ﭗــﻴﻟﻮﭘ عﻮﻴــﺷ ،ﺪــﻧا 2
/ 5
% ﻲــﻣ ﺪــﺷﺎﺑ
3.
و
ﭗــﻴﻟﻮﭘ4
يﺎــﻫ
ًﻻﻮﻤﻌﻣ،ﺪﻨﺘﺴﻫ هﺪﻌﻣ يﺎﻬﭙﻴﻟﻮﭘ عﻮﻧ ﻦﻳﺮﺘﻌﻳﺎﺷ ﻪﻛ ﻚﻴﺘﺳﻼﭘﺮﭙﻴﻫ و هدﻮﺑ ﻪﻳﺎﭘ نوﺪﺑ و ﻞﻜﺷ يﺪﺒﻨﮔ ،ﻚﭼﻮﻛ ةزاﺪﻧا
ﺎـﻬﻧآ ﻂـﺳﻮﺘﻣ 1
ﺮﺘﻤﻴﺘﻧﺎﺳ )
1 / 0 ﺎﺗ 12 ﺮﺘﻤﻴﺘﻧﺎﺳ ( ﻲﻣ ﺪﺷﺎﺑ
4،
و
ﺎﻳ دﺮﻔﻨﻣ ﺖﺳا ﻦﻜﻤﻣ5
ﺪﻨﺷﺎﺑ دﺪﻌﺘﻣ .
ﻗو
ًﻻﻮـﻤﻌﻣ ﺪﻨـﺷﺎﺑ گرﺰـﺑ ﺎـﻳ دﺮﻔﻨﻣ ﻲﺘ ﻪـﻳﺎﭘ
راد
ﺘﺴﻫ ﺪﻨ
6. رد ﻲـﻟو ﺪـﻧراد دﻮـﺟو هﺪـﻌﻣ موﺮﺘﻧا رد ﻊﻳﺎﺷ رﻮﻃ ﻪﺑ
ﻓ ـ ﻧﻮ ﺪ
ﺪﻧﻮـﺷ ﻞﻴﻜـﺸﺗ ﺖـﺳا ﻦﻜﻤﻣ ﻢﻫ ﺎﻳدرﺎﻛ و سو
4. يرﻮـﺌﺗ
ﭗﻴﻟﻮﭘ ﻦﻳا ﻞﻴﻜﺸﺗ
ﻲـﭘا نﻮﻴـﺳاﺮﻧژر ،ﺎﻫ ـﻴﻠﺗ
ـ ﻪـﺑ ﺦـﺳﺎﭘ رد مﻮ
ﻩﺪﻴﻜﭼ : ﭗﻴﻟﻮﭘ ﻲﻣ ﺩﺮﻔﻨﻣ ﺐﻠﻏﺍ ﻭ ﻩﺩﻮﺑ ﺭﺩﺎﻧ ﺭﺎﻴﺴﺑ ﻩﺪﻌﻣ ﮏﻴﺘﺳﻼﭘ ﺮﭙﻳﺎﻫ ﻱﺎﻫ ﺪﻨﺷﺎﺑ
ﻤﻋ. ـ ﺖﻣﻼﻋ ﺕﺭﻮﺻ ﺭﺩ ،ﺪﻨﺘﺴﻫ ﺖﻣﻼﻋ ﻥﻭﺪﺑ ﹰﺎﻣﻮ
ﻱﺰﻳﺮﻧﻮﺧ ﺕﺭﻮﺻ ﻪﺑ ،ﻥﺪﺷ ﺭﺍﺩ
ﺩﺭﺩ ،ﻲﺷﺭﺍﻮﮔ ﮑﺷ ﻱﺩﺍﺪﺴﻧﺍ ﻢﺋﻼﻋ ﺎﻳ ﺱﺭﺩﻭﺯ ﻱﺮﭘ ﺱﺎﺴﺣﺍ ،ﻢﮑﺷ
ـ ﻲﻣ ﺮﻫﺎﻇ ﺏﻭﺎﻨﺘﻣ ﺭﻮﻃ ﻪﺑ ﻢ ﺪﻧﻮﺷ
. ﻤﻴﺑ ـ ﻢﻧﺎﺧ ﺭﺎ ۴۵ ﻟﺎﺳ ـ ﻪ ﻴﻟﻭﺍ ﻪﮐ ﺩﻮﺑ ﻱﺍ ـ
ﻌﺿ ﺖﻳﺎﮑﺷ ﺎﺑ ﺭﺎﺑ ﻦ ـ
،ﻒ
ﻲﺑ ﻴﮔﺮﺳ ،ﻲﻟﺎﺣ ـ
ﻤﻧﺁ ﻭ ﻪﺠ ـ ﺪﻳﺪﺷ ﻲ ) ﻤﻫ ـ ﻦﻴﺑﻮﻠﮔﻮ : ۹ / gr/dl۳ ( ﻣ ـ ﻤﻧ ﻪﻌﺟﺍﺮ ـ ﺩﻮ . ﮑﺷ ﺩﺭﺩ ـ ﻔﻧ ﻭ ﻢ ـ ﻏ ﺯﺍ ﺪﻌﺑ ﺦ ـ ﺍﺬ ﻲﻣ ﺮﮐﺫ ﺍﺭ ﻥﺩﺭﻮﺧ ﺩﺮﮐ
. ﮑﺳﻭﺪﻧﺁ ﺭﺩ ـ ﭗﻴﻟﻮﭘ ﻲﭘﻮ ﻱﺎﻫ
ﻌﺘﻣ ـ ﮕﻧﺍ ﺔﺷﻮﺧ ﻞﮑﺷ ﻪﺑ ﺩﺪ ـ
ﻌﻣ ﺭﺩ ﺭﻮ ـ ﻤﻫ ﻪﺑ ﻩﺪ ـ ﭗﻴﻟﻮﭘ ﻩﺍﺮ ﻳﺎﺳ ﺭﺩ ﻩﺪﻨﮐﺍﺮﭘ ﻱﺎﻫ ـ
ﮔ ﻩﺎﮕﺘﺳﺩ ﻲﺣﺍﻮﻧ ﺮ ـ
ﺪﺷ ﻩﺪﻳﺩ ﺵﺭﺍﻮ
، ﮐ ﭻﻴﻫ ﻪﮐ ـ ﺒﻧ ﻢﻴﺧﺪﺑ ﻡﺍﺪ ـ
ﺪﻧﺩﻮ . ﻞﻤﻋ ﺖﺤﺗ ﺭﺎﻤﻴﺑ
Near Total ﺘﮐﺮﺘﺳﺎﮔ
ـ ﺘﺳﻮﻧﮊﮊﻭﺮﺘﺳﺎﮔﻭ ﻲﻣﻮ ـ
ﻲﻣﻮ ) ﺕﻭﺮﻠﻴﺑ ۲ ( ﻗـ ﻤﻋ ﻝﺎﺣ ﺎﺑ ﻭ ﺖﻓﺮﮔ ﺭﺍﺮ ـ
ﺪﺷ ﺺﺧﺮﻣ ﺏﻮﺧ ﻲﻣﻮ .
ﻦﻳﺪﻨﭼ ﻱﺮﺘﺴﺑ ﺐﻠﻗ ﻲﻳﺎﺳﺭﺎﻧ ﺖﻠﻋ ﻪﺑ ﺖﺑﻮﻧ
ﻭ ﺪﻳﺩﺮﮔ ۱۰ ﻓ ﻪﺿﺭﺎﻋ ﻦﻴﻤﻫ ﺖﻠﻋ ﻪﺑ ﺪﻌﺑ ﻝﺎﺳ ـ
ﺪﺷ ﺕﻮ . ﻌﺗ ﺮﻈﻧ ﺯﺍ ﺩﺭﻮﻣ ﻦﻳﺍ ـ
ﻤﻫ ،ﻪﺘﻓﺮﮔ ﺍﺮﻓ ﺍﺭ ﻩﺪﻌﻣ ﻡﺎﻤﺗ ﻪﮐ ﭗﻴﻟﻮﭘ ﺩﺎﻳﺯ ﺭﺎﻴﺴﺑ ﺩﺍﺪ ـ
ﻖﻃﺎﻨﻣ ﺮﻳﺎﺳ ﺭﺩ ﭗﻴﻟﻮﭘ ﺎﺑ ﻥﺁ ﻲﻫﺍﺮ
ﻋ ،ﺵﺭﺍﻮﮔ ﻩﺎﮕﺘﺳﺩ ـ
ﮔ ﻢﺋﻼﻋ ﺩﻮﺟﻭ ﻡﺪ ـ
ﺷ ﻱﺰﻳﺮﻧﻮﺧ ﺩﻮﺟﻭ ﻥﻭﺪﺑ ﺪﻳﺪﺷ ﻲﻤﻧﺁ ﺯﻭﺮﺑ ﻭ ﺢﺿﺍﻭ ﻲﺷﺭﺍﻮ ﺪﻳﺪ
) ﻴﻠﻋ ـ ﻩﺪﻌﻣ ﺭﺩ ﻊﻴﺳﻭ ﻱﮊﻮﻟﻮﺗﺎﭘ ﻢﻏﺮ (
ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﻲﻤﻴﺧﺪﺑ ﺎﻳ
ﻲﻣ ﺪﺷﺎﺑ .
ﺤﺗ ـ ﺨﻣ ﻚﻳﺮ ـ
ﻲـﻣ ﻦﻣﺰـﻣ بﺎﻬﺘﻟا و طﺎ ﺪـﺷﺎﺑ
3. لﺎـﺜﻣ رﻮـﻃ ﻪـﺑ
ﺘﺳﺎﮔ ـ ﻓوﺮﺗآ ﺖﻳﺮ ﻦﻣﺰـﻣ ﺖﻳﺮﺘﺳﺎﮔ ،سﻮﻴﺴﻴﻧﺮﭘ ﻲﻤﻧآ ،ﻦﻣﺰﻣ ﻚﻴ
ﺘﻧا ـ ﺘﺳﺎﮔ هﮋﻳو ﻪﺑ موﺮ ـ
ﻲﻣﻮﺘﻛﺮﺘـﺳﺎﮔ لﺎـﺗﻮﺗ بﺎـﺳ زا ﺲﭘ ﺖﻳﺮ
ﻲﻣ ﭗﻴﻟﻮﭘ عﻮﻧ ﻦﻳا ﻞﻴﻜﺸﺗ ﻞﻠﻋ زا ﺪﻨﻧاﻮﺗ ﺪﻨﺷﺎﺑ ﺎﻫ
4. ﻲـﻠﻠﻋ ﺮﻳﺎﺳ
ــﺟو ﺎــﻬﻧآ ﻊــﻔﻧ ﻪــﺑ يﺪﻫاﻮــﺷ ﻪــﻛ ـ
زا ﺪــﻨﺗرﺎﺒﻋ ،دراد دﻮ :
Photoablation
ـﻨﻫ هﺪـﻌﻣ ﻪـﺑ نﺎﻳﻼﺘﺒﻣ رد ﻲﭘاﺮﺗ ـ
ﻪﻧاوﺪ يا
7،
هﺪﻌﻣ ﺪﻴﺳا
،اﺮﻔﺻ ﺲﻛﻼﻔﻳر ،يﺎﭼ ،هﻮﻬﻗ ، ﺎـﺑ تﺪﻣ ﻲﻧﻻﻮﻃ نﺎﻣرد
(Proton Pump Inhibitor) PPI
9 -
ﻮﻜﻴﻠﻫ دﺎﻳز لﺎﻤﺘﺣا ﻪﺑ12
هﺪـﻌﻣ ﻚﻴﺘـﺳﻼﭘ ﺮـﭙﻴﻫ ﭗـﻴﻟﻮﭘ دﺎﺠﻳا ﻞﻠﻋ زا ﺰﻴﻧ يرﻮﻠﻴﭘ ﺮﺘﻛﺎﺑ ﻲﻣ ﺪﺷﺎﺑ و ﻲﻣ يﺮﺘﻛﺎﺑ ﻦﻳا ﻲﻨﻛ ﻪﺸﻳر ﺐـﺟﻮﻣ يدوﺪـﺣ ﺎـﺗ ﺪﻧاﻮﺗ
ﭗﻴﻟﻮﭘ ﺖﻓر ﺲﭘ ددﺮﮔ هﺪﻌﻣ يﺎﻫ
8. ﭗﻴﻟﻮﭘ ﺮﺘﺸﻴﺑ هﺪﻌﻣ يﺎﻫ
نوﺪﺑ
ﻲﻣ ﺖﻣﻼﻋ
ﻲـﻣ ﻒـﺸﻛ ﻲﻗﺎـﻔﺗا رﻮـﻃ ﻪـﺑ و ﺪﻨـﺷﺎﺑ ﺪﻧﻮـﺷ
1.
و 3 و 4
ﭗﻴﻟﻮﭘ ﻪﻳﺎﭘ يﺎﻫ ﺲﭘﻻوﺮﭘ ﺎﺑ ﺖﺳا ﻦﻜﻤﻣ ﻊﻳﺎﺷﺎﻧ رﻮﻃ ﻪﺑ موﺮﺘﻧا راد
ﺪﻧﻮـﺷ هﺪـﻌﻣ ﻲـﺟوﺮﺧ داﺪﺴﻧا ﺐﺟﻮﻣ رﻮﻠﻴﭘ ﻞﺧاد ﻪﺑ
13، ﻢـﺋﻼﻋ
دﻮﺑ ﺪﻫاﻮﺧ بوﺎﻨﺘﻣ نارﺎﻤﻴﺑ ﻦﻳا يداﺪﺴﻧا
3.
و
ﭗﻴﻟﻮﭘ14
ﺮـﭙﻴﻫ يﺎـﻫ
شﻮﺧ ﻞﻛ رد هﺪﻌﻣ ﻚﻴﺘﺳﻼﭘ ﺪﻨﺘﺴﻫ ﻢﻴﺧ
ﻲﻤﻴﺧﺪﺑ ﻞﻴﺴﻧﺎﺘﭘ ﻲﻟو
ﺪﻧراد ار ﭗﻴﻟﻮﭘ ﻦﻳا ﻲﻤﻴﺧﺪﺑ ناﺰﻴﻣ ﺎﻫ
5 / 0 ﺎﺗ 1 / 7 شراﺰـﮔ ﺪﺻرد
ﺖﺳا هﺪﺷ
15 -
ﭗﻴﻟﻮﭘ رد هﮋﻳو ﻪﺑ19
زا ﺮﺘﮔرﺰﺑ ﻚﻴﺘﺳﻼﭘﺮﭙﻴﻫ يﺎﻫ 2
ﺮﻤﻴﺘﻧﺎﺳ ﻪﻳﺎﭘ و ﺖﺳا ﺮﺘﺸﻴﺑ ﻲﻤﻴﺧﺪﺑ ﺲﻧﺎﺷ ،راد
6.
و
20
ﻴﻤﻫا ـ ﻣ ﺖ ـ ﻲﻣ ﻲﻓﺮﻌﻣ ﻪﻛ يدرﻮ ﻪﻛ ﺖﺳا ﺖﻬﺟ ﻦﻳا زا ددﺮﮔ
ﻠﻏا ـ ﻴﻟﻮﭘ ﺐ ـ ﭗ ﺳﻼﭘ ﺮﭙﻴﻫ يﺎﻫ ﻲﻣ دﺮﻔﻨﻣ هﺪﻌﻣ ﻚﻴﺘ
ﺎﻬﻨﺗ و ﺪﻨﺷﺎﺑ
رد 27 ﻣ ﺪﺻرد ـ ﻌﺘﻣ دراﻮ ـ ﻲﻣ دﺪ ياراد رﺎـﻤﻴﺑ ﻦـﻳا ﻲـﻟو ﺪﻨﺷﺎﺑ
رد ﭗـﻴﻟﻮﭘ ﻦﻳﺪـﻨﭼ هاﺮـﻤﻫ ﻪـﺑ هﺪﻌﻣ رد ﻚﭼﻮﻛ ﭗﻴﻟﻮﭘ ناراﺰﻫ ﻧدﻮﺋد ـ مﻮ
، ﺧ ـ ﻛ ﻲﻟﺎﺤﻃ ﻢ ـ
ﻲﻣ مﻮﺘﻛر و نﻮﻟﻮ ﺪﺷﺎﺑ
.
ﻌﻣ ـ درﻮﻣ ﻲﻓﺮ
ﻢﻧﺎﺧ رﺎﻤﻴﺑ 45
ﺘﻣ ﻪﻟﺎﺳ ﺄ رﺎـﺑ ﻦﻴﻟوا ﻪﻛ نﺎﺷﺎﻛ ﻞﮔﺪﻴﺑ ﻞﻫا ﻞﻫ
ﺦﻳرﺎﺗ رد 11
/ 02 / 72 و ﻒﻌﺿ ﺖﻳﺎﻜﺷ ﺎﺑ ﻲﺑ
ﻪـﺑ ﻪﺠﻴﮔﺮـﺳ و ﻲﻟﺎـﺣ
دﻮـﻤﻧ ﻪـﻌﺟاﺮﻣ نﺎـﺷﺎﻛ ﻲﺘﺸﻬﺑ ﺪﻴﻬﺷ نﺎﺘﺳرﺎﻤﻴﺑ ﻲﻠﺧاد ﺶﺨﺑ .
ﻲﺑ زا رﺎﻤﻴﺑ اﺬـﻏ زا ﺪﻌﺑ ﺦﻔﻧ و ﻢﻜﺷ درد ﻲﻟو دﻮﺒﻧ ﻲﻛﺎﺷ ﻲﻳﺎﻬﺘﺷا
تﺪﻣ زا بوﺎﻨﺘﻣ رﻮﻃ ﻪﺑ ار ندرﻮﺧ ﻲـﻣ ﺮﻛذ ﻞﺒﻗ ﺎﻫ
دﺮـﻛ . ﺶﻫﺎـﻛ
ﻬﺗ ،ﺮﻴﺧا نزو ـ
ر عﻮﻓﺪـﻣ و زﺎـﮔ ﻊﻓد و ﺖﺷاﺪﻧ غاﺮﻔﺘﺳا ،عﻮ ﻪـﺑ ا
ﻲﻣ ﺮﻛذ ﻲﻌﻴﺒﻃ ترﻮﺻ دﻮﻤﻧ
. ﻘﺑﺎﺳ ﺔ ﻪـﻨﻴﻣز يرﺎﻤﻴﺑ يﺮﺘـﺴﺑ و يا
ﻲﻤﻧ ار ﻲﻠﺒﻗ ﻘﺑﺎﺳ رد داد
ﺔ ﺖـﻠﻋ ﻪـﺑ ار ردﺎـﻣ گﺮﻣ ،دﻮﺧ ﻲﻠﻴﻣﺎﻓ
ﻲﻣ ﺮﻛذ ،دﻮﺑ هﺪﺸﻧ ﻪﺘﺧﺎﻨﺷ ﺖﻗد ﻪﺑ ﻪﻛ ﻲﺷراﻮﮔ تﻼﻜﺸﻣ و دﺮـﻛ
دﻮﺑ ﺮﻛﺬﺘﻣ ﺰﻴﻧ ار ناﺪﻧزﺮﻓ رد ﻪﻤﺿﺎﻫ ءﻮﺳ ﻦﻴﻨﭽﻤﻫ .
،دورو وﺪﺑ رد
لﺎﺣ ﺪﺑ ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻲﻟو ﺪﻴﺳر
ﻮﺗ ﻚﻴﺴﻛ ﻲﺗﺎـﻴﺣ ﻢﺋﻼﻋ و دﻮﺒﻧ شا
دﻮﺑ ﻲﻌﻴﺒﻃ .
تﺪﺷ ﻪﺑ رﺎﻤﻴﺑ ،هﺪﺷ مﺎﺠﻧا تﺎﻨﻳﺎﻌﻣ رد هﺪـﻳﺮﭘ ﮓـﻧر
اﺮﻠﻜﺳا ،دﻮﺑ دﻮﺒﻧ ﻚﻳﺮﺘﻜﻳا
. ﺪـﺸﻧ ﺲﻤﻟ ﻲﺗﺎﭘﻮﻧدﺎﻔﻨﻟ .
ـﻨﻳﺎﻌﻣ رد ﺔ
ﻪﺟرد ﻚﻴﻟﻮﺘﺴﻴﺳ ﻞﻓﻮﺳ ﺐﻠﻗ 2
ﺪـﺷ ﻊﻤﺳ .
ـﻨﻳﺎﻌﻣ رد ﺔ
،ﻢﻜـﺷ
ﻲﭘا سرﺪﻨﺗ ﺖﺷاد فﺎﻧ فاﺮﻃا و ﺮﺘﺳﺎﮔ
. نﻮﻴـﺴﻧﺎﺘﺴﻳد و ﺖﻴـﺳآ
ﻣ ﺮﻳﺎــﺳ ﻪﺘــﺷاﺪﻧ ﻢﻜــﺷ دﻮــﺑ ﻲــﻌﻴﺒﻃ تﺎــﻨﻳﺎﻌ
. تﺎــﺸﻳﺎﻣزآ رد
WBC=4900 ، 665000 ،PLT=
=RBC
6 / 2 ،نﻮـــــــــﻴﻠﻴﻣ
ﻦﻴﺑﻮــﻠﮔﻮﻤﻫ
= 9 / g/dl3 ﺖــﻳﺮﻛﻮﺗﺎﻤﻫ ،
= 4 /
٪14 ﺎــﺑ MCV=55 ،
MCHC=27 ﺖﺷاد
.
ﺰﻴﻧآ ﻲـﻄﻴﺤﻣ نﻮـﺧ مﻻ رد و
زﻮﺘﻴـﺳ + 3 ،
زﻮﺘﺳﻮﻠﻴﻛ ﻲﺋﻮﭘ +
2 ﺒﻠﮔ و ـ لﻮ ﺰﻣﺮﻗ يﺎﻫ ﻚﻴﺘﺳوﺮﻜﻴﻣ موﺮﻛﻮﭙﻳﺎﻫ
ﺪـﺷ هﺪﻳد .
ـﻣ رد ﻲـﻔﺨﻣ نﻮـﺧ ـ
ﺎـﻧ لوا ﺖـﺑﻮﻧ عﻮﻓﺪ رد و ﺰﻴﭼ
ﺖﺑﻮﻧ دﻮﺑ ﻲﻔﻨﻣ ،مﻮﺳ و مود يﺎﻫ .
دﺎـﻣ ﻚـﻳرﺎﺑ هدور ﺖﻳﺰﻧاﺮﺗ رد ة
ﺌﻠﻳا ﻪﭽﻳرد ﻪﺑ ﻲﻌﻴﺒﻃ نﺎﻣز رد ﺐﺟﺎﺣ ـ
ﺪﻴﺳر لﺎﻜﺳﻮ .
ﺺﻘﻧ يﺎـﻫ
دﻮـﺑ ﻲـﻌﻴﺒﻃ ﻚـﻳرﺎﺑ هدور ،ﺪـﺷ هﺪـﻳد هﺪـﻌﻣ رد ﻲﻜﭼﻮﻛ .
رد
آ ﻜﺳوﺪﻧ ـ هﺪﻴـﺷﻮﭘ مﻮﻧدﻮﺋد مﻮﺳ ﺖﻤﺴﻗ ﺎﺗ ﺎﻳدرﺎﻛ ياﺪﺘﺑا زا ﻲﭘﻮ
زا ﻫ ـ ﻳﺎﭘ نوﺪﺑ ﻲﻤﺧز ﺮﻴﻏ ﭗﻴﻟﻮﭘ ناراﺰ ﻪﻳﺎﭘ و ﻪ
زاﺪـﻧا ﻪﺑ راد ة
2 / 0
ﺎﺗ 2 ﺮﺘﻤﻴﺘﻧﺎﺳ ﺪﺷ هﺪﻳد
. هﺮﻈﻨﻣ طﺎﻘﻧ ﻲﻀﻌﺑ رد
ـﺷﻮﺧ ﻪﻴﺒـﺷ يا ﺔ
ﻲﻣ ﻪﺟﻮﺗ ﺐﻠﺟ رﻮﮕﻧا دﺮﻛ
. ﺘﮔرﺰﺑ ـ دوﺪﺣ ﭗﻴﻟﻮﭘ ﻦﻳﺮ 2
ﺮﺘﻤﻴﺘﻧﺎﺳ و
ﻪﻳﺎﭘ
ﺪـﺷ هﺪـﻳد مﻮـﻧدﻮﺋد مود ﺶﺨﺑ رد راد .
ﻲﭘﻮﻜـﺳﻮﻧﻮﻟﻮﻛ رد
ﭗﻴﻟﻮﭘ ﻚﻳ و ﻲﺟرﺎﺧ ﺪﻴﺋورﻮﻤﻫ 5
× 6 ﻲﻠﻴﻣ ﺮﺘﻣ رد ﻪـﻳﺎﭘ نوﺪﺑ 18
ﻲﺘﻧﺎﺳ يﺮﺘﻣ ﻪﻳﺎﭘ ﭗﻴﻟﻮﭘ و ﮕﻳد راد
ـ ﻪﻠﺻﺎﻓ رد يﺮ 8
ﻲﺘﻧﺎﺳ يﺮـﺘﻣ
ﺪﺷ هﺪﻳد جرو لﺎﻧآ زا .
ﺤﻃ ﻪﻳواز رد ـ
دﺎﻌﺑا ﻪﺑ ﻲﭙﻴﻟﻮﭘ ﺰﻴﻧ ﻲﻟﺎ 5
× 5
ﻲﻠﻴﻣ ﺮﺘﻣ ﺪﻳدﺮﮔ هﺪﻫﺎﺸﻣ .
ﻛ ـ
ـﻌﺻ و ﻲـﺿﺮﻋ نﻮﻟﻮ ـ
ﭗـﻴﻟﻮﭘ يدﻮ
ﭗﻴﻟﻮﭘ زا ﺖﺷاﺪﻧ ﻣ يﺎﻫ
ـ
ﺪـﺷ ﻪـﻴﻬﺗ ﻲﺴﭘﻮﻴﺑ دﻮﺟﻮ .
ـﻴﺘﻧ رد ـ ﻪﺠ
ﭗـﻴﻟﻮﭘ ﻲﻣﺎﻤﺗ ،يژﻮﻟﻮﺗﺎﭘ
ـﭙﻳﺎﻫ عﻮـﻧ زا ﺎـﻫ ـ
ﻚﻴﺘﺳﻼﭘﺮ نوﺪـﺑ و
ﺪﺷ شراﺰﮔ ﻲﻤﻴﺧﺪﺑ زا يﺪﻫاﻮﺷ )
ﺮﻳﻮﺼﺗ 1 ( .
ﺮﻳﻮﺼﺗ ۱ ﻟﻮﭘ ـ ﻴ ﻩﺪﻌﻣ ﺯﻮﭙ
نﻮـﺧ ﻖﻳرﺰﺗ و تﺎﻔﻟﻮﺳوﺮﻓ صﺮﻗ ﺎﺑ ﻲﺒﻃ نﺎﻣرد ﺖﺤﺗ رﺎﻤﻴﺑ ﻦﻴﺑﻮﻠﮔﻮﻤﻫ ﺎﺑ و ﺖﻓﺮﮔ راﺮﻗ 6
/ 6
ﺪـﺷ ﺺﺧﺮـﻣ ﻲـﻠﺧاد ﺶﺨﺑ زا .
ًادﺪﺠﻣ ﺦﻳرﺎﺗ رد 07
/ 10 / 76 ﻲﺑ ،ﻒﻌﺿ ﺖﻳﺎﻜﺷ ﺎﺑ ﻪﺠﻴﮔﺮـﺳ ،ﻲﻟﺎﺣ
ﺤﺗ ماﺪﻧا و ﺖﻴﺑرا هﺮﭘ مدا هاﺮﻤﻫ ﻪﺑ دﻮـﻤﻧ ﻪﻌﺟاﺮﻣ ﻲﻧﺎﺘ
. تﺎـﻨﻳﺎﻌﻣ
دﻮـﺑ ﻞﺒﻗ رﺎﺑ ﻪﺑﺎﺸﻣ رﺎﻤﻴﺑ .
ﻦﻴﺑﻮـﻠﮔﻮﻤﻫ ،تﺎـﺸﻳﺎﻣزآ رد
= g/dl3 ،
=MCV
MCHC,73 =
30 ﻲـﻔﺨﻣ نﻮﺧ و دﻮﺑ +
2 عﻮﻓﺪـﻣ رد
ﺖﺷاد دﻮﺟو .
ﻠﮔﻮﻤﻫ ـ ﺪﺣ ﺎﺗ رﺎﻤﻴﺑ ﻦﻴﺑﻮ mg/dl12
و ﺪﺷ ﺢﻴﺤﺼﺗ
ﻚﻴﺘـﺳﻼﭘﺮﭙﻳﺎﻫ ﭗـﻴﻟﻮﭘ ﺺﻴﺨﺸﺗ ﺎﺑ رﺎﻤﻴﺑ ،ﻲﺣاﺮﺟ هروﺎﺸﻣ ﻲﻃ ﻌﻣ ـ ﺟ ﻞﻤﻋ ﺖﺤﺗ ،هﺪ ـ
ﻗ ﻲﺣاﺮ ـ راﺮ ﺖﻓﺮﮔ . ﻂـﺧ شﺮـﺑ ﺎـﺑ ﻢﻜـﺷ
ﺪﺷ زﺎﺑ ،ﻻﺎﺑ ﻂﺳو .
ﻫﺎﻇ رد هﺪﻌﻣ ـ
ﺮ 5 زاﺪﻧا ﺮﺑاﺮﺑ ة
زا ﺮـﭘ و ﻲﻌﻴﺒﻃ
ﻴﻟﻮﭘ ـ دﻮﺑ ﭗ . ﭗﻴﻟﻮﭘ ﻧدﻮﺋد ﻞﺧاد ﻪﺑ ﺎﻫ ـ
ﺪـﻧدﻮﺑ هﺪـﺷ ﻪـﺑﻻوﺮﭘ مﻮ .
ﻧدﻮﺋد اﺪﺘﺑا ـ
ﺪﺷ دازآ مﻮ .
ﺰﻴﻧ مﻮﻧدﻮﺋد ﻞﺧاد 2
نوﺪـﺑ ﭗﻴﻟﻮﭘ دﺪﻋ
ﻣ ﻚﻳ و ﻪﻳﺎﭘ ـ
ﻪﻳﺎﭘ درﻮ
ﺪـﺷ ﻪﺘـﺷادﺮﺑ ﻪـﻛ ﺪﺷ هﺪﻳد راد .
ﺲﭙـﺳ
Near Total ــﺘﻛﺮﺘﺳﺎﮔ
ـ ترﻮــﺻ ﻲﻣﻮﺘــﺳﻮﻧژژوﺮﺘﺳﺎﮔ و ﻲﻣﻮ
ﮔ ـ ﺖﻓﺮ . ﻌﻣ نﺪﺷ زﺎﺑ زا ﺪﻌﺑ ـ
ـﻫ ،هﺪ ـ ﺮـﺳﺎﺗﺮﺳ رد ﭗـﻴﻟﻮﭘ ناراﺰ
داﺪـﻌﺗ ﻪـﺑ ﺞﻳرﺪﺗ ﻪﺑ ﻪﻛ هﺪﺷ عوﺮﺷ ﺎﻳدرﺎﻛ زا ﻪﻛ ﺪﺷ هﺪﻳد هﺪﻌﻣ ﻓا ﺎﻬﻧآ ـ ﺘﻧا رد و هﺪﺷ هدوﺰ ـ
هﺪﻴـﺳر دﻮـﺧ داﺪﻌﺗ ﺮﺜﻛاﺪﺣ ﻪﺑ موﺮ
ﺪﻧدﻮﺑ . ﻜﺷ ﻪﻴﻘﺑ ﻲﺳرﺮﺑ ـ
دﻮﺑ ﻲﻌﻴﺒﻃ ﻢ .
،يژﻮﻟﻮﺗﺎﭘ شراﺰﮔ رد ﺮﺜﻛا
ﭗﻴﻟﻮﭘ
ـﻌﺗ ،هدﻮـﺑ رﻻﻮﺑﻮﺗ ﺎﻫ ـ
داﺪـﻌﺗ و سﻮـﻠﻳوﻮﻟﻮﺑﻮﺗ ﻢـﻫ يداﺪ
ﺪﺷ شراﺰﮔ ﻲﺳﻮﻠﻳو يﺮﺘﻤﻛ .
ﻲﻣﻮـﻤﻋ لﺎﺣ ﺎﺑ ﺪﻌﺑ ﻪﺘﻔﻫ ود رﺎﻤﻴﺑ
ﺪــﺷ ﺺﺧﺮــﻣ و بﻮــﺧ .
2 ــﻬﺟ رﺎــﻤﻴﺑ ﺪــﻌﺑ هﺎــﻣ ـ
ــﻴﮕﻴﭘ ﺖ ـ يﺮ
آ ﺪﺷ ﻲﭘﻮﻜﺳﻮﻧﻮﻟﻮﻛ و ﻲﭘﻮﻜﺳوﺪﻧ
، هﺪـﻳد ﻲـﻌﻴﺒﻃ ﺮـﻴﻏ درﻮﻣ ﻪﻛ
ﺪﺸﻧ ) ﺮﻳﻮﺼﺗ 2 ( .
ﺮﻳﻮﺼﺗ ۲ ـ ﮔ ـ ﻲﻓﺍﺮ ـﻴﮕﻴﭘ ﻪﺑ ﻁﻮﺑﺮﻣ ﻲﺣﺍﺮﺟ ﺯﺍ ﺪﻌﺑ ﻪﺘﻔﻫ ﻭﺩ ،ﺭﺎﻤﻴﺑ ﻱﺮ
5
ﺪﻌﺑ لﺎﺳ ) لﺎﺳ 1381 ( ﺖﻳﺎﻜﺷ ﺎﺑ رﺎﻤﻴﺑ ﺎـﺑ ﻞﺒﻗ ﻪﺑﺎﺸﻣ يﺎﻫ
ﻦﻴﺑﻮﻠﮔﻮﻤﻫ
= 1 / g/dl6 MCV،
= 95 دﻮﻤﻧ ﻪﻌﺟاﺮﻣ .
رد آ ﻲﭘﻮﻜﺳوﺪﻧ
ﻴﺣﺎﻧ زا ،هﺪﻣآ ﻞﻤﻋ ﻪﺑ ﺔ
ﭗـﻴﻟﻮﭘ هﺪـﻌﻣ هﺪﻧﺎﻣ ﻲﻗﺎﺑ رد ﺎﻳدرﺎﻛ يﺎـﻫ
ﺖﺷاد دﻮﺟو يﺪﻳﺪﺟ ناواﺮﻓ .
ﻪـﻴﻬﺗ ﻲـﺴﭘﻮﻴﺑ ﺎﻬﻧآ زا يداﺪﻌﺗ زا
،ﺪﺷ ﻨﭽﻤﻫ
ﺖـﺷاﺪﻧ دﻮـﺟو ﻲﻤﻴﺧﺪـﺑ ﺪﻫاﻮـﺷ يژﻮﻟﻮﺗﺎـﭘ رد نﺎ .
ﻪﺘﻓﺎﻳ ﺎﺑ ﻖﺑﺎﻄﻣ ﺰﻴﻧ ﻲﭘﻮﻜﺳﻮﻧﻮﻟﻮﻛ يﺎﻫ 5
دﻮﺑ ﻞﺒﻗ لﺎﺳ .
رﺎـﻤﻴﺑ ﻪـﺑ
ﻲﻣﻮﺘﻛﺮﺘﺳﺎﮔ لﺎﺗﻮﺗ
ﻲـﺼﺨﺷ ﺖﻳﺎـﺿر ﺎـﺑ رﺎﻤﻴﺑ ﻲﻟو ﺪﺷ ﻪﻴﺻﻮﺗ
ﺪﺷ ﺺﺧﺮﻣ .
لﺎﺳ رد 85 ،ﭗـﭼ مﻮﻳدرﻮﻛ هﺮﭘ درد ﺖﻳﺎﻜﺷ ﺎﺑ رﻮﻛﺬﻣ رﺎﻤﻴﺑ
ﺖﺳد مدا ،ﺲﻔﻧ ﻲﮕﻨﺗ ﺪﻳدﺮﮔ يﺮﺘﺴﺑ ﺎﻫﺎﭘ و ﺎﻫ
. ﻬﺟ ﺮﺴﻛ ﻲﺸ 25
ﺎﺗ 30
% ﻦﻴﺑﻮﻠﮔﻮﻤﻫ و
= 1 / 12 ﻦﻴﻣﻮﺒﻟآ و
= 9 / 1 ﺖﺷاد
، ﺪﻌﺑ ﻪﺘﻔﻫ ﻚﻳ
ﺪﺷ تﻮﻓ ﭗﭼ ﻦﻄﺑ ﺪﻳﺪﺷ ﻲﻳﺎﺳرﺎﻧ ﺖﻠﻋ ﻪﺑ .
ﺚﺤﺑ ﻪﺠﻴﺘﻧ و يﺮـﻴﮔ
ﺐﻠﻏا ﻪﻛ ﺖﺳا ﺖﻬﺟ ﻦﻳا زا ﺪﻳدﺮﮔ ﻲﻓﺮﻌﻣ ﻪﻛ يدرﻮﻣ ﺖﻴﻤﻫا ﭗﻴﻟﻮﭘ ﻲﻣ دﺮﻔﻨﻣ هﺪﻌﻣ ﻚﻴﺘﺳﻼﭘﺮﭙﻳﺎﻫ يﺎﻫ رد ﺎﻬﻨﺗ و ﺪﻨﺷﺎﺑ
27
%
ﻲﻣ دﺪﻌﺘﻣ دراﻮﻣ ﺪﻨﺷﺎﺑ
3.
و
ﺑ ﻦﻳا ﻲﻟو4
ﭗـﻴﻟﻮﭘ ناراﺰـﻫ ياراد رﺎﻤﻴ
ﻢـﺧ و مﻮـﻧدﻮﺋد رد ﭗـﻴﻟﻮﭘ ﻦﻳﺪـﻨﭼ هاﺮﻤﻫ ﻪﺑ هﺪﻌﻣ رد ﻚﭼﻮﻛ دﻮﺑ مﻮﺘﻛر و نﻮﻟﻮﻛ ﻲﻟﺎﺤﻃ .
ﭗﻴﻟﻮﭘ ﺮـﭙﻴﻫ يﺎﻫ هﺪـﻌﻣ ﻚﻴﺘـﺳﻼﭘ
ﻲﻣ ﺖﻣﻼﻋ نوﺪﺑ ﺐﻠﻏا ﺪﻨﺷﺎﺑ
1 و 3 و
ﺖﻣﻼﻋ دراﻮﻣ رد4
تاﺮﻫﺎـﻈﺗ ،راد
داﺪـﺴﻧا ﺎـﻳ و ﻲﻧﺎـﻗﻮﻓ شراﻮـﮔ هﺎﮕﺘـﺳد زا يﺰﻳﺮﻧﻮﺧ ترﻮﺻ ﻪﺑ ﻲﻣ
3ﺪﺷﺎﺑ ﻤﻴﺑ ﻦﻳا ﻲﻟو و ﻒﻌـﺿ تﺎﻳﺎﻜـﺷ ﺎـﺑ تﺎﻌﻓد ﻲﻣﺎﻤﺗ رد رﺎ
ﻲﺑ دﻮﻤﻧ ﻪﻌﺟاﺮﻣ ﻪﺠﻴﮔﺮﺳ و ﻲﻟﺎﺣ و ﺎـﻨﻠﻣ ،يﺰـﺷﻮﺗﺎﻤﻫ ،ﺰﻤﺗﺎﻤﻫ و
مﺪﻋ ،ﻢﻜﺷ نﻮﻴﺴﻧﺎﺘﺴﻳد ،غاﺮﻔﺘﺳا ،عﻮﻬﺗ ﻞﻣﺎﺷ يداﺪﺴﻧا ﻢﺋﻼﻋ ﺖﺷاﺪﻧ عﻮﻓﺪﻣ و زﺎﮔ ﻊﻓد .
ـــﻤﻴﺑ ـ ـــﻜﻴﻣ ﺪﻳﺪـــﺷ ﻲـــﻤﻧآ رﺎ ـ
ﺳوﺮ ﻴ ﺖـــﺷاد ﻚﻴﺘ
) ﻦﻴﺑﻮﻠﮔﻮﻤﻫ
= 9 / 3 MCV ،
= MCHC,55
= 27 ( ﭗﻴﻟﻮﭘ ﺎﺑ ﻪﻛ يﺎﻫ
ﻴﻏ ـ ز ﺮ
ﻲـﻤﻧ ﻪـﻴﺟﻮﺗ وا هﺪـﻨﻫد يﺰﻳﺮﻧﻮﺧ ﺮﻴﻏ و ﻲﻤﺧ رد و ﺪـﺷ
ﻲﺳرﺮﺑ ﺘﺣ ﻪﻴﻟوا يﺎﻫ ـ
شراﺰـﮔ وا عﻮﻓﺪـﻣ رد ﺰﻴﻧ ﻲﻔﺨﻣ نﻮﺧ ﻲ
ﺖﺳا هﺪﺸﻧ .
ﻴﺳ رد ﻪﺘﺒﻟا ـ
لﺎـﺳ رد و يرﺎﻤﻴﺑ ﺮ نﻮـﺧ ﺪـﻌﺑ يﺎـﻫ
ﻔﺨﻣ ـ ﻣ رد ﻲ ـ ﻴﺨﺸﺗ عﻮﻓﺪ ـ
رﺎـﻤﻴﺑ ﻲﻤﻧآ ﻦﻴﻨﭽﻤﻫ و ﺪﺷ هداد ﺺ
ﻴﻴﻐﺗ ﻚﻴﺘﺳوﺮﻛﺎﻣ عﻮﻧ ﻪﺑ ـ
ﻛ اﺪﻴﭘ ﺮ ـ ﻲﻣ نآ ﻪﻴﺟﻮﺗ رد ﻪﻛ دﺮ ناﻮﺗ
ﺒﻤﻛ ﻪﺑ ـ ﻤﺘﺣا دﻮ ـ ـﻓ ﺪﻴﺳا ﻲﻟﺎ ـ
ـﻤﻧ هرﺎـﺷا ﻚﻴﻟﻮ ـ
دﻮ . ﻦﻴـﻨﭽﻤﻫ
Near Total ﻦﻴﻣﺎـﺘﻳو ﻲـﻘﻳرﺰﺗ ﺖﻓﺎﻳرد ﻢﻏﺮﻴﻠﻋ ﻲﻣﻮﺘﻛﺮﺘﺳﺎﮔ
ﻲﻣB12 ﻪـﻴﺟﻮﺗ ﻲـﻠﺧاد رﻮﺘﻛﺎـﻓ ﺢـﺷﺮﺗ ﺶﻫﺎـﻛ ﺖﻠﻋ ﻪﺑ ﺪﻧاﻮﺗ
ﺪﺷﺎﺑ رﺎﻤﻴﺑ ﻚﻴﺘﺳوﺮﻛﺎﻣ ﻲﻤﻧآ ياﺮﺑ ﻲﺒﺳﺎﻨﻣ .
ﻲـﺳرﺮﺑ ﻲﻟو يﺎـﻫ
ﻞﻣﺎﻛ ﺢﻄﺳ ﻦﻴﻴﻌﺗ ﺖﻬﺟ يﺮﺗ رﺎﻤﻴﺑ ﻦﻳا رد ﻲﻠﺧاد رﻮﺘﻛﺎﻓ وB12
ﺪﺸﻧ مﺎﺠﻧا .
مرﺪﻨﺳ ﻢﺋﻼﻋ رﺎﻤﻴﺑ ﻦﻳا زﻮﭙﻴﻟﻮﭘ يﺎﻫ
) ﺮﮕﺟ ﺰﺗﻮﭘ
ـ تﻮﻛرﻮﺗ ـ
ﺮﻧدرﺎﮔ Cowdenـ (
ﺮﻳﺎـﺳ رد هﺪـﻌﻣ ﺰـﺟ ﻪـﺑ ﻲـﻟو ﺖﺷاﺪﻧ ار
ﺖﻤﺴﻗ ﭗﻴﻟﻮﭘ ياراد ﺰﻴﻧ شراﻮﮔ هﺎﮕﺘﺳد يﺎﻫ ﻚﻴﺘﺳﻼﭘﺮﭙﻴﻫ يﺎﻫ
دﻮﺑ . ﻘﺑﺎﺳ ﺔ ﺼﻣ ـ ﻬﻣ يﺎﻫوراد فﺮ ـ
نﻮـﺗوﺮﭘ ﭗﻤﭘ هﺪﻨﻨﻛ رﺎ )
زا ﻪـﻛ
ﻞﻠﻋ ﻤﺘﺣا ـ ﻴﻟﻮﭘ دﺎﺠﻳا ﻲﻟﺎ ـ
ﻲﻣ ﭗ ﺪﻨﺷﺎﺑ ( ار ﻛذ ـ ﻲﻤﻧ ﺮ دﺮﻛ .
ﭗﻴﻟﻮﭘ ﻦﻳا دﺎﺠﻳا ﻪﻛ ﻦﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
ًﻼﺒـﻗ ﻪـﻛ ﻲﻧارﺎﻤﻴﺑ رد ﺎﻫ
هﺪﺷ ﻲﺣاﺮﺟ ﻲﻣ ردﺎﻧ ﻲﻟو ﻞﻤﺘﺤﻣ ﺪﻧا
ﺪﺷﺎﺑ ) زا ﺮﺘﻤﻛ عﻮﻴﺷ 5
% ( و
ﻞــﻤﻋ مﺎــﺠﻧا زا ﺪــﻌﺑ ﺰــﻴﻧ رﻮﻛﺬــﻣ رﺎــﻤﻴﺑ رد Near Total
ﭗﻴﻟﻮﭘ ،ﻲﻣﻮﺘﻛﺮﺘﺳﺎﮔ ﺪﻧﺎﻣ ﻲﻗﺎﺑ ﺶﺨﺑ رد يﺪﻳﺪﺟ يﺎﻫ
ـﺑ هﺪﻌﻣ ه ﻪ
ﻲﻣ دﺎﻬﻨﺸﻴﭘ ،دﻮﺑ هﺪﻣآ دﻮﺟو
ـﻴﻠﻛ دﻮـﺷ ﺔ
ﺖـﺤﺗ ﻪـﻛ ﻲﻧارﺎـﻤﻴﺑ
ﻲﻣ راﺮﻗ هﺪﻌﻣ ﻲﺣاﺮﺟ يﺮـﻴﮕﻴﭘ ،ﺪـﻧﺮﻴﮔ
آ ﺮـﻈﻧ زا ﻚﻴﭘﻮﻜـﺳوﺪﻧ
دﺮﻴﮔ مﺎﺠﻧا ﭗﻴﻟﻮﭘ دﻮﺟو .
ردﺎﻣ ﻪﻜﻨﻳا ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ ﺖـﻠﻋ ﻪـﺑ رﺎـﻤﻴﺑ
ءﻮـﺳ ﻪـﺑ ﺰـﻴﻧ وا ناﺪـﻧزﺮﻓ و ﺖـﺳا هدﻮﻤﻧ تﻮﻓ ﻲﺷراﻮﮔ ﻞﻜﺸﻣ ﻧژ ﻞﺋﺎﺴﻣ ﺖﺳا ﻦﻜﻤﻣ ،ﺪﻧدﻮﺑ ﻼﺘﺒﻣ ﻪﻤﺿﺎﻫ دﺎﺠﻳا رد ﻲﺛرا و ﻲﻜﻴﺘ
ﭗﻴﻟﻮﭘ ﺪﻨـﺷﺎﺑ ﻪﺘﺷاد ﺶﻘﻧ ﺰﻴﻧ ﻲﻣرﺪﻨﺳ ﺮﻴﻏ ﻚﻴﺘﺳﻼﭘﺮﭙﻳﺎﻫ يﺎﻫ
هرﺎـﺷا ﻲـﻠﺒﻗ تﻻﺎﻘﻣ رد ﻪﻛ و ﺖـﺳا هﺪـﺸﻧ درﻮـﻣ ﻦـﻳا ﻪـﺑ يا
ﻲﺳرﺮﺑ ﻲﻣ ﺐﻠﻃ ار يﺮﺘﺸﻴﺑ يﺎﻫ ﺪﻳﺎﻤﻧ
.
Abstract:
Report of a Rare Case of Gastric Polyposis
Case Report and Review of Literature
Javanmardi M. MD. FIAS*, Naghavi Ravandi M. MD**, Mianeh Saz E***
Hyperplastic polyps are very rare and often solitary. Usually they have no symptoms, if they were symptomatic, they would have gastro intestinal (GI) bleeding, abdominal pain, early fullness of stomach, intermittent obstructive pattern. The patient was a 45 year old woman that complained about fatigue, malaise, dizziness and had severe anemia (Hb: 3.9 gr/dl). She didn’t mention abdominal pain, bloating and, other GI disorders. In endoscopy, many grape like polyps were seen in the stomach; also scattered ones in other parts of GI were observed which none of them were malignant. The patient was operated (Billirot II) and discharged with good general condition. She was hospitalized 4 times during 11 years after surgery because of cardiac decompensation and died finally due to Congestive Heart Failure. The case is interesting and considerable because of the large amount of polyps in the stomach, a few polyps in other parts of GI, absence of obvious alimentary signs or symptoms, severe anemia without active GI bleeding (in spite of extensive pathology in the stomach) or malignancy.
Key Words: Gastric Polyposis, Hyperplastic Polyp, Anemia
*Assistant Professor of Surgery, Kashan University of Medical Sciences and Health Services, Hospital, Kashan, Iran
**Resident of General Surgery, Kashan University of Medical Sciences and Health Services, Hospital, Kashan, Iran
***MedicalStudent, Kashan University of Medical Sciences and Health Services, Kashan, Iran
References:
1. Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock R. E. Schwartz’s principles of surgery. McGraw Hill. Volume I. 2005.
2. Archimandritis A, Spiliadis C, Tzivras M, et al.
Gastric epithelial polyps. Ital J Gastroenterol 1996;
28: 387.
3. Bynum TE. Gastric Polyp.. Uptodate 2006 (online).
4. Odze RD. Antonioli. DA Pathology and clinical features of gastric polyps. uptodate 2006 (online).
5. Stoltle M, Sticht T, Edit S, et al. Frequency, location, age and sex distribution of various types of gastric polyps. Endoscopy 1994; 26: 659.
6. Yamada T, Alpers DH, Kaplowitz N, Laine L, et al.
Text book of Gastroenterology volume 2 - 4th edition: lipincott Williams & wilkinds (LWW) 2916- 2917.
7. Geller A, Gostout CJ, Balm RK, et al. Development of hyperplastic polyps following laser therapy for watermelon stomach. Gastrointest Endosc 1996; 43:
54.
8. Ohkusa T, Takashimizu I, Fujiki K, et al.
Disappearance of hyperplastic polyps in the stomach after eradication of Helicobacteria pylori: A randomized controlled trial. Ann Intern Med 1998;
129: 179.
9. Stolte M, Bethke B, Seifert E, et al. observation of gastric glandular cysts in the corpus of the stomach under omeprazole treatment. Gastroenterol 1995; 33:
146.
10. El - zimaity HM, Jackson FW, Graham DY. Fundic gland polyps developing during omeprazole therapy.
Am J Gastroenterol 1997; 92: 1858.
11. Moldin IM, Giligan CJ, Lawton GP, et al. Gastric carcinoids. The Yale experience. Arch Surg 1995;
130: 250.
12. Choudhry U, Boyce HW Jr, Coppola D. proton pump inhibithor - associated gastric polyps: A retrospective analysis of their frequency, and endoscopic, histologic, and ultrastructural characterisitics. Am J Clin Pathol1998; 110: 615.
13. Kumar A, Quick CR, Carr - Locke DL, et al.
prolapsing gastric polyp: An unusual case of gastric outlet obstruction.Endoscopy 1996; 28:452.
14. Genosmanglo R. sen - Dran E, Kurtkaya - yapicier O, Tozun N. Antral hyperplastic polyp causing intermitted gastric outlet obstraction case report, BMC Gastroenterol 2003 Jun 27; 3: 16.
15. Kamiya T, Morishita T, Asakura H, et al.
Histoclinical longstanding follow up study of hyperplastic polyps of the stomach. Am J Gastroenterol 75: 275-281, 1981.
16. Daibo M, Itabashi M, Hirota T. Malignant transformation of gastric hyperplastic polyps. Am J Gasteroenterol 82: 1016-1025, 1987.
17. Orlwska J, Jarosz D, Pachlewski J, et al: Malignant transformation of being epithelial gastric polyps. Am J Gastroenteril 90: 2152-2159, 1995.
18. Hizawa K, Fuchigami T, Iida M, et al. Possible neoplastic transformation within gastric hyperplastic pylop. Application of endoscopic polypectomy. Surge Endosc 9: 714-718, 1995.
19. Zea - Iriarte WL, sekine I, Itsuno M, et al.
Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci 41: 377-386, 1996.
20. Antonioli DA. Precuresors of gastric carcinomas.
Hum Pathol 1994; 25:994.
