炎症性肠病回盲部溃疡内镜下特征性表现与鉴别诊断

Endoscopic features and differential diagnosis of inflammatory bowel disease ileocecal ulcerative

摘要:

目的 观察回盲部溃疡性病变黏膜特征性改变，初步诊断和鉴别诊断，为临床诊断提供有力依据。 方法 收集该院自2008年1月-2014年12月行结肠镜检查诊断为炎症性肠病性溃疡43例，观察溃疡特点及黏膜特征性改变。结果 回盲部溃疡性病变内镜下特征性表现主要分为3种：溃疡表浅斑片地图状、溃疡较深不规则，沟槽状和回盲瓣瓣口受累变形伴假息肉形成。结果显示以上3种内镜下特征性改变，在单项及两组构成比方面，溃疡性结肠炎（UC）患者和克罗恩病（CD）患者比较，差异有统计学意义（P <0.01），可以作为根据其作出初步的鉴别诊断。结论 CD、UC均缺乏诊断的金标准，诊断需结合临床、内镜和组织病理学表现进行综合分析并随访观察，但有一定的特征性表现及规律可循。所以在组织病理学没有充分证据的情况下，观察病变的内镜下特征性表现就显得尤为重要，可能会对临床诊断提供有力的依据。降低此类病变在诊断上的盲目性，提高回盲部溃疡性病变病因确诊率。

Abstract:

Objectives To observe the characteristics of the mucosa of the patients with ulcerative lesions in the blind area, and to provide a strong evidence for the clinical diagnosis. Methods 43 patients diagnosed inflammatory bowel disease ulcer by colonoscopy from January 2008 to December 2014, we observed the ulcer characteristics and mucosa characteristic changes. Results The lesions' characteristics under endoscopy were mainly divided into three types: the map of the ulcer and the depth of the ulcer, and the shape of the groove and the back of the flap. The results showed that the characteristics of the three types of endoscopic changes, in the individual and the two groups of patients with UC, patients and CD patients with difference (P < 0.01), can be used as a preliminary differential diagnosis. Conclusions CD and UC are lack of diagnostic criteria. The diagnosis should be combined with clinical, endoscopic and histopathological features of the comprehensive analysis and follow-up observation, but there are certain characteristics and rules to follow. So, in the case of insufficient evidence of tissue pathology, it is very important to observe the characteristics of the lesions, which may provide a useful basis for clinical diagnosis. Reduce the blindness in the diagnosis of the disease, improve the diagnosis rate of the disease in the back of the blind.