251例回盲部病变的肠镜检查及临床分析

发布时间：2018-04-21 12:45

本文选题：回盲部病变 + 临床分析　；参考：《皖南医学院》2014年硕士论文

【摘要】：目的：回顾性分析251例回盲部病变，总结回盲部各种病变的种类、分布、临床特点、病理特征等，评估结肠镜及病理组织学检查对回盲部溃疡性病变的确诊价值，重点分析肠镜下各类型回盲部溃疡的特点，以加强对回盲部各疾病的认识，为临床回盲部疾病的诊疗工作提供帮助。材料与方法：收集我院自2010年12月至2013年12月肠镜检查中检出的251例回盲部病变的患者，所有患者均行肠镜检查，采用PENTAX公司EC-3870Fk、EC-3890Fi电子结肠镜，所有病例均检查至回盲部。对其性别、年龄、临床特点、内镜下诊断及病理学检查进行总结分析。重点探讨回盲部溃疡性疾病如溃疡性结肠炎、克罗恩病、肠结核、恶性淋巴瘤、结肠癌（溃疡型）的诊断及鉴别诊断等。采用SPSS19.0标准化数据库进行统计学处理。结果：1.本组资料中男性140例，女性111例，比例为1.26:1，年龄15岁～84岁，平均年龄53.37±15.06岁，临床表现以腹痛、腹泻、便血、腹部包块为多见。 2.病变部位和性质：病变位于盲肠129例(51.39%),回盲瓣33例(13.15%),升结肠始端例34例(13.55%),回肠末端31例(12.35%),阑尾开口24例(9.56%),如病变累及2个或2个以上部位称为多部位,有38例。 3.病理检查结果：回盲部炎症71例，其中行病理活组织检查提示为黏膜慢性炎症者为56例，余15例未行病理检查；回盲部息肉57例，炎性及增生性息肉43例、腺瘤性息肉14例；回盲部憩室20例，回盲部癌35例，以中低分化腺癌为主。淋巴瘤9例，8例为弥漫性大B细胞淋巴瘤，1例为套细胞淋巴瘤。溃疡性结肠炎19例，克罗恩病9例，肠结核2例，非特异性溃疡29例。 4.在确诊的病例中，回盲部溃疡性疾病包括溃疡性结肠炎（多为全结肠炎累及回盲部）、克罗恩病、肠结核、淋巴瘤、肠癌共74例。腹痛、腹泻、发热在回盲部溃疡性疾病的比较中，统计学上无明显差异。其他症状如便血、腹部包块、消瘦在回盲部溃疡性疾病的比较中，差异有统计学意义。其中，便血以溃疡性结肠炎多见，腹部包块和消瘦以回盲部癌及恶性淋巴瘤多见。 5.内镜结合病理活检对回盲部溃疡性病变的鉴别诊断具有重要价值。对于回盲部癌、溃疡性结肠炎的诊断价值极高，但对于克罗恩病及肠结核的鉴别诊断仍较困难。 6.不同疾病的溃疡具有不同的内镜下特点。溃疡性结肠炎镜下全结肠弥漫性水肿，糜烂，溃疡，包括回盲部充血，糜烂，糜烂及溃疡的末端回肠。纵行裂隙状溃疡为克罗恩病的特点。溃疡伴单一肿块形成者多见于回盲部癌。仍有少数病例（淋巴瘤、肠结核、阑尾粘液囊腺癌）内镜及活检仍无法确诊，最终通过术后病理及试验性治疗后确诊。结论：回盲部病变以炎性病变占首位，息肉其次，回盲部癌第三，溃疡性结肠炎、肠结核、克罗恩病及淋巴瘤等均不多见。性别上，男性较女性略多，平均年龄在50岁左右。从发病部位来看，病变发生于盲肠最多，靠近回盲部的升结肠始端其次，阑尾处最少见。回盲部溃疡性疾病的临床表现上呈现非特异性。多数表现为腹痛、腹泻、排便习惯改变、便血等，恶性肿瘤还有腹部包块、消瘦等。内镜和内镜活检对重症溃疡性结肠炎、结肠直肠癌（溃疡）有较高的诊断价值。但对于肠结核，Crohn氏病和恶性淋巴瘤的诊断价值不高，，鉴别较困难。由于镜下病理检查只能局限的从黏膜取材进行活检,无法观察到肠壁全层及病变的全貌,也不易发现一些特征性病变。因此，对于回盲部溃疡性病变，虽然内镜下溃疡的典型形态学特征不同，但一次活检并不能完全确诊，这就导致了疾病的漏诊和误诊，所以，总体来说，我们需根据临床表现、内镜活检病变特征结合在一起综合分析来提高回盲部病变病因诊断率。
[Abstract]:Objective: To review 251 cases of ileocecal lesions, summarize the types, distribution, clinical features and pathological features of the ileocecal lesions, evaluate the diagnostic value of colonoscopy and histopathology for the ulcerative lesions of the ileocecal region, and focus on the characteristics of all types of ileocecal ulceration under the enteroscopy, so as to strengthen the understanding of all the diseases in the ileocecal part. The diagnosis and treatment of the clinical ileocecal disease is helpful.
Materials and methods: 251 cases of ileocecal lesions were detected in our hospital from December 2010 to December 2013. All the patients were examined by enteroscopy, using PENTAX company EC-3870Fk and EC-3890Fi electron colonoscopy. All cases were examined to the ileocece. The sex, age, clinical characteristics, endoscopic diagnosis and pathological examination were performed. The diagnosis and differential diagnosis of ulcerative diseases such as ulcerative colitis, Crohn's disease, intestinal tuberculosis, malignant lymphoma, colon cancer (ulcerative type) and so on. The SPSS19.0 standardized database was used for statistical treatment.
Results: 1. in 1. of the data, there were 140 males and 111 females, the proportion was 1.26:1, the age was 15 years to 84 years old, the average age was 53.37 + 15.06 years. The clinical manifestations were abdominal pain, diarrhea, blood, and abdominal mass.
2. lesion location and nature: the lesions were located in 129 cases (51.39%) of cecum, 33 cases of ileocecal valve (13.15%), 34 cases (12.35%) at the beginning of ascending colon, 31 cases (12.35%) at the distal ileum and 24 cases (9.56%) of appendix opening, such as lesions involving 2 or more than 51.39% sites, and there were 38.
3. pathological examination results: 71 cases of ileocecal inflammation, including 56 cases of chronic inflammation of mucous membrane and 15 cases without pathological examination, 57 cases of ileocecal polyps, 43 cases of inflammatory and proliferative polyps, 14 adenomatous polyps, 20 cases of ileocecal diverticulum and 35 cases of ileocecal carcinoma, 9 cases of lymphoma and 8 lymphoma, 9 cases of lymphoma, 8. Diffuse large B cell lymphoma, 1 case of mantle cell lymphoma, 19 cases of ulcerative colitis, 9 cases of Crohn's disease, 2 cases of intestinal tuberculosis, 29 cases of non-specific ulcers.
4. in the confirmed cases, the ulcerative disease of the ileocecal region including ulcerative colitis (mostly colitis involving ileocecal), Crohn's disease, intestinal tuberculosis, lymphoma, and colon cancer, 74 cases, abdominal pain, diarrhea, and fever in the ileocecal ulcer disease, statistically indistinct. Other symptoms such as blood, abdominal mass, and emaciation in the ileocecal part There were significant differences in the comparison of ulcerative diseases. Among them, there were many cases of ulcerative colitis, abdominal mass and emaciation in the cases of ileocecal and malignant lymphoma.
5. endoscopy combined with pathological biopsy is of great value in the differential diagnosis of ulcerative diseases in the ileocecal region. It is of high value for the diagnosis of ileocecal carcinoma and ulcerative colitis, but it is still difficult for the differential diagnosis of Crohn's disease and intestinal tuberculosis.
6. the ulcers of different diseases have different endoscopic characteristics. Diffuse edema, erosion, ulcers, including hyperemia, erosion, erosion and ulcers at the end of the ileocecal region. The diagnosis of tumor, biopsy and biopsy of the appendiceal mucinous cystadenocarcinoma is still undiagnosed.
Conclusion: the lesions of the ileocecal region were the first of inflammatory lesions, and the polyps were second, third of the ileocecal carcinoma, ulcerative colitis, intestinal tuberculosis, Crohn's disease and lymphoma were not common. In sex, the male was a little more than the female, the average age was about 50 years. The most rare appendix. The clinical manifestations of ulcerative disease in the ileocecal region are nonspecific. Most of them are abdominal pain, diarrhea, changes in bowel habits, blood and so on, malignant tumor and abdominal mass, emaciation, etc.. Endoscopy and endoscopic biopsy are of high diagnostic value for severe ulcerative colitis, colorectal cancer (ulcers), but for intestinal tuberculosis, Croh The diagnostic value of n's disease and malignant lymphoma is not high and difficult to identify. Because the pathological examination can only be limited by biopsy of the mucosa from the mucosa, it is impossible to observe the whole appearance of the whole intestinal wall and the lesion, and it is not easy to find some characteristic lesions. Therefore, the typical morphological characteristics of ulcerative disease in the ileocecal region are not good. In the same way, a biopsy can not be completely confirmed, which leads to a missed diagnosis and misdiagnosis of the disease. Therefore, in general, we need to combine the features of the endoscopic biopsy with a comprehensive analysis to improve the diagnostic rate of the ileocecal lesion.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574

【参考文献】