摘要
目的分析结肠镜发现的良性回肠末端和／或回盲瓣溃疡的病例特点和病理特点。方法回顾性分析2000年1月至2005年12月在北京大学第一医院消化内科进行结肠镜检查的门诊或住院患者的临床资料，入选标准为末端回肠和／或回盲瓣溃疡，直径≥0．2cm，数目≤3个。入选31例患者，平均年龄47岁±17岁，男17例，女14例。结果症状包括腹痛、腹泻、便秘、便血、发热、体重下降等，以腹痛最为常见，占64．5％（20／31），右下腹痛占19．4％（6／31）。溃疡最大直径0．2—1．0cm者20例，〉1．0cm者11例。溃疡发生在回盲瓣或回结肠吻合口者分别为17例和3例，末端回肠7例，回盲瓣和末端回肠均有者4例。单发溃疡17例，多发溃疡14例。溃疡边缘清晰，溃疡周围及溃疡之间的黏膜正常。活检病理组织学表现多无特异性。14例未能确定病因，其中12例为小型溃疡患者。10例患者诊断为克罗恩病，其他诊断包括肠结核（2例）、缺血性肠炎（2例）、Beheet’s病（1例）、艾滋病相关（1例）和阿司匹林相关（1例）。结论良性回盲部溃疡多表现为腹痛，但并不一定存在右下腹痛；病理组织学检查多无特异性表现，但有时能提供关键性证据；回盲部溃疡病因学诊断困难，需综合分析所有临床资料。
Objective To investigate the clinical and pathological features of benign ileocecal ulcerative lesions proven by ileo-colonoscopy. Methods The clinical data of 31 patients, 17 males and 14 females, aged （47 ± 17） （17 -76） with distal ileal ulcers and/or ulcers of ileocecal valve, ≥2 mm in diameter, confirmed by colonscopy were analyzed. Results The clinical manifestations included abdominal pain, lower right abdominal pain, diarrhea, constipation, hematochezia, fever, and body weight loss. Abdominal pain was found in 20 patients （64.5%） and lower right abdominal pain in 6 （ 19.4% ）. 20 patients had the ulcers 0.2 - 1.0 cm in diameter and the ulcers of 11 patients were larger than 1.0 cm. The sites of ulcers included ileocecal valve （ 17 cases） , anastomotic stoma after resection of ileocecal valve （3 cases） , distal ileum （7 cases） , and both ileocecal valve and distal ileum （4 cases）. Single ulcer was seen in 17 patients and multiple in 14. The ulcers were sharply demarcated, without remarkable inflammation around or between the ulcers. Histopathological findings were mostly unspecific, such as chronic inflammation, active inflammation, ulceration, eosinophil infiltration, inflammatory granulomation, granuloma, and thickness of vessel wall. Mostly, the causes of ulcer were of unknown origin （ 14 cases）, especially for those of small size （ 12 cases）. 10 cases （32.3%） were diagnosed as Crohn＇s disease. The other diagnoses were intestinal tuberculosis, ischemia, Behcet＇s disease, AIDS, and NSAIDs-associated ulcers. Conclusion Most patients with benign ileocecal ulcers complain of abdominal pain, but lower right abdominal pain is not always present. The pathological findings are mostly not specific, but sometimes are critical for the diagnosis. The etiology was difficult to be confirmed and all the clinical data should be reviewed carefully.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2008年第12期823-825,共3页
National Medical Journal of China
