41例回盲部溃疡的诊治分析

发布时间：2018-04-01 13:06

本文选题：回盲部溃疡　切入点：溃疡性结肠炎　出处：《新疆医科大学》2017年硕士论文

【摘要】：目的:回顾分析我院回盲部良性病变中溃疡患者的住院资料,探讨近年来回盲部溃疡患者住院病例的特点,加以总结,旨在为回盲部溃疡的诊断,鉴别诊断及治疗提供借鉴。方法:收集2013年11月到2015年5月在我院消化科内镜中心行结肠镜检查发现的回盲部良性病变,筛选出镜下表现为溃疡的病例,就其临床特征、内镜及病理检查、影像学及特殊检查,治疗及随访情况等对回盲部溃疡病例进行回顾性总结分析。重点探讨各类疾病的临床表现、实验室检查、内镜及活检结果、治疗及转归。结果:肠镜下发现的回盲部良性病变143例中,溃疡性病变有41例,其中非特异性溃疡18例(43.9%),内镜结合活检检出率为94.4%,形态整齐或局限,大部分病例可经抗炎、培菲康及谷参肠安等对症治疗后缓解。溃疡性结肠炎10例(24.4%),内镜结合活检检出率为90%,镜下表现为弥漫性充血糜烂并浅溃疡形成,病变范围广泛,重度活动期者可累及全结肠,经艾迪莎及激素治疗后症状缓解。肠结核9例(22.0%),多有腹泻,并伴发热、体重减轻,右下腹压痛阳性率高.溃疡镜下表现为不规则凹陷形节段性溃疡,呈环型发展。5例内镜活检组织病理检查诊断肠结核,诊断率为55.6 %, 3例试验性抗结核治疗后有效支持诊断。克罗恩病4例(9. 76%) , 2例便血,内镜结合活检检出率为25%,镜下表现为沿肠壁纵行节段性溃疡,病变连续,呈铺路石样改变。其中1例诊断性治疗后随访证实,2例复查肠镜溃疡病变好转。41例回盲部溃疡患者中,完善CT检查的33例,20例有阳性发现。胸部X线检查中,2例患者发现纤维增值性肺结核,为肠结核的确诊提供了依据。9例肠结核患者中,完善结核感染T细胞斑点试验(T-SPOT)检查8例,结果为阳性者6例,阳性率高达75%。本组4例确诊为克罗恩病的患者中,3例完善炎症性肠病血清学检查,阳性者2例。此2例按克罗恩病治疗后病情好转。结论:1.溃疡性结肠炎内镜及活检诊断率高,其镜下特点为弥漫性溃疡,多数溃疡由从直肠发展至回盲部,病变呈连续性。非特异性溃疡多数经抗炎,谷参肠胺及培菲康治疗有效。肠结核及克罗恩病内镜及活检诊断率低,诊断性抗结核治疗对二者的鉴别有重要意义。2.肠结核溃疡多为不规则凹陷形节段性溃疡,呈环型发展,溃疡表面及周围黏膜可有息肉样增生结节。克罗恩病的溃疡多为沿肠壁纵行节段性溃疡,病变连续。增生结节多见于肠结核,铺路石样改变及管腔狭窄多见于克罗恩病。3.肠结核与克罗恩病的鉴别诊断仍为一个难题,特异性血清检查,如T-spot、炎症性肠病抗体检查对肠结核与克罗恩病的鉴别诊断发挥着重要作用。同时应继续寻找一种特异性指标辅助回盲部溃疡的诊断及鉴别诊断。
[Abstract]:Objective: to analyze retrospectively the clinical data of patients with ileocecal ulcer in our hospital, to explore the characteristics of the patients with ileocecal ulcer in recent years, and to summarize the characteristics of the cases, in order to diagnose ileocecal ulcer. Methods: from November 2013 to May 2015, we collected the benign ileocecal lesions from November 2013 to May 2015, and screened out the patients with ulcers under endoscopy. Endoscopic and pathological examination, imaging and special examination, treatment and follow-up were used to summarize and analyze retrospectively the cases of ileocecal ulcer, with emphasis on the clinical manifestations, laboratory examination, endoscopy and biopsy results of various diseases. Results: among 143 cases of ileocecal benign lesions found under enteroscopy, there were 41 cases of ulcerative lesions, of which 18 cases were nonspecific ulcers. The detection rate of endoscopic biopsy was 94.4%. 10 cases of ulcerative colitis were treated with 24. 4% of ulcerative colitis. The detection rate of endoscopy combined with biopsy was 90%. Under microscope, diffuse hyperemia and shallow ulceration were observed, with a wide range of lesions. The patients with severe active stage could be involved in the whole colon. After treatment with Adisha and hormone, the symptoms were alleviated in 9 cases of intestinal tuberculosis with diarrhea, fever, weight loss, high positive rate of right lower abdomen tenderness, and irregular hollow segmental ulcers under endoscopy. The diagnosis rate of intestinal tuberculosis was 55.6, 3 cases of experimental anti-tuberculosis treatment were effective, 4 cases of Crohn's disease (4 cases), 2 cases of hematochezia (2 cases), the diagnosis rate of intestinal tuberculosis was 55.6%, the diagnosis rate was 55.6%, the diagnosis was effective after experimental anti-tuberculosis treatment, 4 cases were Crohn's disease. The detectable rate of endoscopic biopsy was 25. The findings were as follows: longitudinal segmental ulcers along the wall of the intestine, the lesions were continuous, and the lesions presented as paving stone changes. One case was followed up after diagnostic treatment and 2 cases were confirmed to have improved the ulceration of ileocecal ulcer in 1 case, and in 41 cases of ileocecal ulcer, there were 41 cases of ileocecal ulcer. Among 33 cases of CT examination, 20 cases were positive, 2 cases of fibroblast pulmonary tuberculosis were found in chest X-ray examination, which provided basis for the diagnosis of intestinal tuberculosis in 9 cases. T-SPOT (T cell spot test) for tuberculosis infection was completed in 8 cases, 6 cases were positive, the positive rate was as high as 75%. In this group of 4 patients diagnosed as Crohn's disease, 3 cases were perfect in the serological examination of inflammatory bowel disease. Two cases were positive. These two cases were improved after treatment with Crohn's disease. Conclusion 1.The diagnostic rate of endoscopy and biopsy of ulcerative colitis is high. The characteristic of the ulcerative colitis is diffuse ulcer, most of which develop from rectum to ileocecal region. The lesions were continuous. Most of the nonspecific ulcers were treated with anti-inflammatory drugs. The diagnosis rate of endoscopy and biopsy of intestinal tuberculosis and Crohn's disease was low. Diagnostic antituberculous therapy is of great significance in differentiating the two. 2. Intestinal tuberculosis ulcers are mostly irregular and concave segmental ulcers, which develop in annular type. The ulcer surface and surrounding mucosa may have polypoid hyperplastic nodules. Crohn's disease ulcers are mostly along the intestinal wall longitudinal segment ulcers, the lesions are continuous. Hyperplastic nodules are more common in intestinal tuberculosis, The differential diagnosis of intestinal tuberculosis and Crohn's disease is still a difficult problem. For example, the detection of antibodies to inflammatory bowel disease plays an important role in the differential diagnosis of intestinal tuberculosis and Crohn's disease. At the same time, we should continue to look for a specific index to assist the diagnosis and differential diagnosis of ileocecal ulcer.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574

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