摘要
目的结合胶囊内镜结果分析回肠末端溃疡的临床特征,为临床诊治提供帮助。方法回顾114例结肠镜发现回肠末端溃疡行活检病理并胶囊内镜检查患者的病例资料,其中3例行小肠镜检查,结合临床数据及随访信息进行分析。结果结肠镜结合胶囊内镜结果显示:114例患者中孤立回肠末端溃疡47例、小肠多发溃疡67例,伴有糜烂炎症15例、血管畸形2例、息肉2例、淋巴管扩张23例。病理活检结果显示:黏膜急慢性炎伴局部淋巴组织增生68例,黏膜急慢性炎伴肉芽肿形成29例,黏膜急慢性炎伴隐窝脓肿形成13例,间质嗜酸性粒细胞浸润4例,抗酸染色阳性1例,综合临床分析诊断非特性小肠溃疡67例(58.8%)、克罗恩病25例(21.2%)、溃疡性结肠炎(倒灌性小肠溃疡)13例(11.0%)、肠结核4例(3.4%)、嗜酸细胞性胃肠炎4例(3.4%)、腹型过敏性紫癜1例(0.8%)。胶囊内镜未发现回肠末端溃疡6例,漏诊率为5.3%(6/114)。91例(79.8%)在治疗后随访3~6个月,其中有持续症状的9例患者(9.9%)接受重复回结肠镜检查,结果显示多个回肠末端溃疡持续存在,其中2例诊断为克罗恩病,1例诊断肠为结核;46例(56.1%)症状消退患者重复回结肠镜检查,有76.1%(35/46)观察到回肠末端溃疡消失。结论回肠末端溃疡临床症状及内镜下表现无特异性,胶囊内镜可为小肠疾病的诊断、鉴别和复查等提供依据和指向。非特异性溃疡可以通过对症治疗随访,症状持续存在需要密切监视和重新评估。建议结肠镜检查应尽可能至回肠末端,发现问题行胶囊内镜初筛,必要时进一步指导小肠镜来准确定位活检。
Objective To analyze the clinical features of terminal ileum ulcers in combination with capsule endoscopy results,and provide assistance for clinical diagnosis and treatment.Methods The clinical data of 114 patients with terminal ileum ulcers detected by colonoscopy and confirmed by pathological biopsy,and undergoing capsule endoscopy were retrospectively analyzed.Among them,3 cases underwent small bowel endoscopy.Clinical data and follow-up information were analyzed.Results Colonoscopy combined with capsule endoscopy results showed that among the 114 patients,47 had isolated terminal ileum ulcers,and 67 had multiple ulcers in the small intestine,accompanied by inflammation in 15 cases,vascular anomalies in 2 cases,polyps in 2 cases,and lymphatic vessel dilation in 23 cases.Pathological biopsy results showed that there were 68 cases of mucosal acute and chronic inflammation with local lymphoid tissue hyperplasia,29 cases of mucosal acute and chronic inflammation with granuloma formation,13 cases of mucosal acute and chronic inflammation with crypt abscess formation,4 cases of eosinophilic infiltration in the stroma,1 case of acid-fast staining positive,and 67 cases(58.8%)of non-specific small intestine ulcers,25 cases(21.2%)of Crohn’s disease,13 cases(11.0%)of ulcerative colitis(reflux small intestine ulcers),4 cases(3.4%)of intestinal tuberculosis,4 cases(3.4%)of eosinophilic gastroenteritis,and 1 case(0.8%)of abdominal cutaneous vasculitis.Six cases were not found to have terminal ileum ulcers by capsule endoscopy,with a missed diagnosis rate of 5.3%(6/114).91 patients(79.8%)were followed up for 3-6 months after treatment,and 9 patients(9.9%)with persistent symptoms underwent repeated colonoscopy,which showed multiple terminal ileum ulcers,including 2 cases of Crohn’s disease and 1 case of intestinal tuberculosis.Among the 46 patients(56.1%)with symptom improvement who underwent repeated colonoscopy,76.1%(35/46)showed disappearance of terminal ileum ulcers.Conclusions The clinical symptoms and endoscopic ma
作者
吴蓉
李国熊
吴建良
李国栋
李丽
WU Rong;LI Guoxiong;WU Jianliang;LI Guodong;LI Li(Department of Gastroenterology,The Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)
出处
《健康研究》
CAS
2023年第2期221-225,F0003,共6页
Health Research
关键词
回肠末端溃疡
胶囊内镜
病因
随访
terminal ileum ulcers
capsule endoscopy
etiology
follow-up
