经腹肠道超声诊断小肠克罗恩病并发症

目的 评估经腹肠道超声（TBUS）诊断小肠克罗恩病（SBCD）并发症的价值。方法 回顾性分析25例确诊SBCD患者10年42例次超声检查,包括活动期26例次（活动期组）、缓解期16例次（缓解期组）的声像图特征,观察超声评估病变活动度结果与Harvey-Bradshaw指数（HBI）的一致性。结果 TBUS与HBI评估病变活动度的一致性较高（Kappa=0.897）。瘘、脓肿、炎性包块均见于活动期组;活动期组狭窄、爬行脂肪征、淋巴结炎、腹腔积液等发生率均明显高于缓解期组（P均<0.05）,肠壁及爬行脂肪厚度明显大于缓解期组（P均<0.01）。42例次超声检查中,15例次见肠管狭窄,8例次见瘘;31例次病变肠壁周围脂肪组织炎性增生,20例次见多发肠系膜淋巴结炎;腹腔积液16例次,腹部包块9例次,其中5例次伴脓肿,穿孔1例次,炎性息肉8例次,憩室形成3例次。结论 TBUS能准确显示SBCD腹部并发症,可作为评估SBCD并发症的常规影像学检查手段。     

口服2.5%甘露醇溶液后小肠超声造影检查诊断小肠克罗恩病及其并发症

目的 观察口服2.5%甘露醇溶液后小肠超声造影检查（SICUS）诊断小肠克罗恩病（CD）及其并发症的价值。方法 前瞻性纳入135例小肠CD患者,根据C反应蛋白（CRP）水平将其分为轻微组（n=66）和严重组（n=69）,对比观察常规肠道超声（IUS）、SICUS及MR小肠造影（MRE）诊断小肠CD及其并发症的效能。结果 对所有135例及轻微组66例患者,SICUS对检出小肠CD 的敏感度均高于IUS而低于MRE（P均<0.05）;对严重组69例患者,SICUS检出小肠CD的敏感度高于IUS（P<0.05）,而与MRE差异无统计学意义（P>0.05）。所有患者中,SICUS检出小肠CD的特异度高于MRE（P<0.05）。SICUS检出小肠CD合并狭窄的敏感度均高于IUS及MRE（P均<0.05）,而其特异度差异均无统计学意义（P均>0.05）。结论 口服2.5%甘露醇溶液后SICUS有助于诊断小肠CD及其并发症,特别是肠腔狭窄;结合MRE可提高检出轻微小肠CD的敏感度。     

经腹肠道超声诊断克罗恩病合并肠瘘及肠腔狭窄

目的 观察经腹肠道超声诊断克罗恩病(CD)合并肠瘘及肠腔狭窄的价值。方法 回顾性分析337例CD患者,观察其肠道超声及CT小肠造影(CTE)表现,分析二者诊断CD合并肠瘘的一致性;以手术结果为金标准,评价超声及CTE诊断CD合并肠瘘和肠腔狭窄的效能。结果 337例中,超声及CTE同时诊断CD合并肠瘘48例,诊断一致性极高(Kappa=0.848,P＜0.01)。34例接受手术治疗,其中27例存在肠瘘;超声诊断CD合并肠瘘的敏感度、特异度及准确率分别为92.59%、71.43%及88.24%,CTE诊断的敏感度、特异度及准确率分别为96.30%、71.43%及91.18%,二者差异无统计学意义(McNemar P＞0.05)。27例CD合并肠瘘患者中,18例同时合并肠腔狭窄;超声诊断CD合并肠瘘和肠腔狭窄的敏感度、特异度及准确率分别为88.89%、77.78%及85.19%,CTE诊断的敏感度、特异度及准确率均为88.89%,二者差异无统计学意义(McNemar P＞0.05)。结论 经腹肠道超声诊断CD合并肠瘘和肠腔狭窄效能较高,可媲美CTE。     

克罗恩病活动期常规超声及超声造影特征分析

目的分析克罗恩病活动期常规超声及超声造影特征。方法回顾性分析2011年8月至2012年12月上海市第十人民医院经临床确诊为克罗恩病活动期的20例患者,观察其腹部常规超声及超声造影特征。测量病变段肠壁全层、内侧及外侧肠壁厚度、内外侧肠壁厚度之比;对肠壁能量多普勒超声表现进行Limberg分型;测量肠壁造影剂到达时间、达峰时间、流入时间。不同Limberg分型克罗恩病患者肠壁厚度、造影剂到达时间、达峰时间、流入时间比较应用方差分析,进一步组间两两比较应用LSD．t检验。结果20例克罗恩病患者肠壁全层厚度均大于4mm,为5．5～12．0mm,平均（8．8±0．4）mm;内外侧肠壁厚度之比均大于1。20例克罗恩病患者LimbergII型2例、III型8例、Ⅳ型10例。超声造影主要表现为2种增强模式：13例（13／20,65．0％）表现为内外侧肠壁同时开始的全肠壁增强;7例（7／20,35．0％）表现为从内侧肠壁开始的以内侧肠壁为主的增强。LimbergII型、III型、Ⅳ型克罗恩病患者肠壁全层厚度分别为（6．6±0．1）、（7．5±0．4）、（10．2±0．4）mm,内侧肠壁厚度分别为（3．6±0．6）、（5．0±0．2）、（7．3±0.3）mm,超声造影达峰时间分别为（30．5±2．1）、（26．9±2．4）、（21,0±1．6）S,流入时间分别为（18．0±5．7）、（10．6±1．0）、（8．7±1．2）S。随着Limberg分型增加,克罗恩病患者肠壁全层厚度、内侧肠壁厚度均增加,超声造影达峰时间及流入时间亦增加,且差异均有统计学意义。随着Limberg分型增加,克罗恩病患者内外侧肠壁厚度比也增加,但差异均无统计学意义。不同Limberg分型克罗恩病患者外侧肠壁厚度、肠壁造影剂到达时间差异均无统计学意义。结论克罗恩活动期患者常规超声主要表现为肠壁增厚,能量多普勒Limberg分型增加：超声造影主要表现为肠壁全层均匀增强或以内侧肠壁增强为主：各表现之间有一定关系。     

克罗恩病的超声研究进展

近年来,超声检查已广泛用于克罗恩病(CD)的研究。超声在CD的初步筛查、疾病活动性评估及治疗监测中均发挥重要作用。本文主要对CD的超声研究进展进行综述。     

经腹肠道超声对克罗恩病的诊断价值及其表现

目的 探讨经腹肠道超声诊断克罗恩病(CD)的价值。方法 对33例CD患者行经腹肠道超声检查,分析超声图像,并与内镜和(或)消化道造影结果相对照;对肠壁血流进行分级,并检测C反应蛋白(CRP)。结果 CD超声主要表现为受累肠壁不同程度增厚,呈"靶环征"、"三明治征";增厚肠壁回声层次多消失,内膜面呈平板状或"鹅卵石样改变";超声可显示深裂隙状溃疡及较大的黏膜溃疡、并能发现肠管蠕动异常。CD易并发肠管狭窄、炎性包块、肠瘘、穿孔及脓肿;受累肠壁周围出现"爬行脂肪征"。病变类型以小肠-结肠型最多见(16/33,48.48%),其次为小肠型(11/33,33.33%),结肠型占15.15%(5/33),胃-回肠型占3.03%(1/33)。受累肠壁血流分级与CRP存在显著相关(r=0.59,P<0.01),一致性中等(Kappa=0.58,P<0.01)。结论 经腹肠道超声检查在CD的诊断和随访中具有独特优势。     

经腹联合经会阴超声在克罗恩病管理中的临床价值

摘 要 目的 探讨经腹联合经会阴超声检查对克罗恩病评估的应用价值。方法 选取我院收治的克罗恩病患者87例,均行经腹超声联合经会阴超声检查,观察空回肠及结直肠的肠壁厚度、肠壁血流分级、肠道弹性成像值、肠外并发症情况;肠镜检查肠壁炎症程度并进行SES-CD评分及组织学活检;实验室检查收集患者超敏C反应蛋白浓度。分析各超声参数与肠镜检查结果、C反应蛋白的相关性。结果 本研究87例CD患者中,同时进行超声及肠镜检查的肠段共计435个。肠镜检查提示缓解期肠段326个（74.94%）,活动期肠段109个（25.06%）。其中末段回肠受累者59.8%（52/87）处于活动期。相关分析显示,肠壁厚度、Limberg血流分级均与SES-CD分期呈高度正相关（r=0.796、0.742,均P＜0.001）;末段回肠肠壁厚度、Limberg血流分级分别与超敏C反应蛋白呈中度正相关、弱正相关（r=0.496、0.399,均P＜0.05）;各肠段SWE值与SES-CD评分无相关性。结论 经腹联合经会阴肠道超声能够清晰显示克罗恩病患者的肠道病变及肠外并发症,可以较准确地评估病变的活动度,有一定的临床价值。     

小肠克罗恩病的诊断

炎症性肠病（inflammatory bowel disease,IBD）的两个主要类型为克罗恩病（Crohn’sdisease,CD）和溃疡性结肠炎（ulcerative colitis,UC）,而少数不能归入这两类者则称未定型。IBD的病因迄今不明,但胃肠道免疫反应异常是其共同特点。IBD是一全球性疾病,多见于北欧和北美洲,发病率约为5／10万人．患病率为50／10万人，在犹太人中尤高。我国IBD患者并不少见，且近年其发病率有上升趋势。     

采用无线胶囊内镜检查诊断小肠克罗恩病

克罗恩病 (crohn′sdisease,CD)可以侵犯胃肠道的任何部位 ,但是小肠是最常受犯的部位。当今检查小肠的方法为X线和内镜检查。该项研究的目的是评估无线胶囊内镜检查对采用过传统方式检查未能明确的小肠可疑CD患者的诊断效果。符合录入标准的 17例患者 [8例男性 ,平均年龄 (40± 15 )岁 ]完成了研究 ,9例患者为缺铁性贫血 [平均血红蛋白 (10 .5± 1.8) g/L],8例腹痛 ,7例腹泻及 3例体重下降。小肠和胃肠内镜所见正常。诊断前的平均症状持续时间为 (6 .3± 2 .2 )年。方法为每个受试者吞下一个MZAGivenCapsule,胶囊含有一部微型视频像机…     

CEUS评估克罗恩病的活动性

目的 探讨CEUS在克罗恩病(CD)活动性评估中的应用价值。方法 对经临床确诊为CD的54例患者分别行二维超声、彩色多普勒超声及CEUS检查,观察肠壁厚度、病变处血供情况及病变肠壁血流灌注模式。CD活动性评价参考指标为CD疾病活动指数(CDAI)。结果 CEUS评估CD活动性的敏感度、特异度、准确率分别为95.56%(43/45)、66.67%(6/9)、90.74%(49/54)。CEUS评估CD活动性与CDAI相关性较高(r=0.71,P<0.05),高于二维超声及彩色多普勒超声(r=0.60、0.52,P均<0.05)。结论 CEUS可反映CD的肠壁血流灌注模式,能提示肠壁炎症活动状态,可作为评估CD活动性的一种手段。     

正常小肠的MSCT表现

目的 总结口服及灌肠双重肠道准备后小肠MSCT各种正常表现.方法 对44名健康志愿者,经结肠、小肠双充盈法准备后,对小肠进行测量,包括肠壁厚度、肠管充盈直径、肠壁分层、肠壁CT值、空肠黏膜皱襞数、肠系膜脂肪密度、肠系膜血管影以及肠系膜淋巴结和后腹膜淋巴结MSCT显示率等.结果 小肠总的肠壁厚度平均值为(1.72±0.20)mm;整个小肠平均充盈肠管直径(21.24±3.05)mm;小肠各组段肠壁平扫、增强动脉期和门静脉期平均CT值分别为(28.13±0.38)HU、(55.42±0.88)HU和(67.86±0.94)HU;正常小肠每厘米肠段内可见的空肠黏膜皱襞数为2.29个,肠系膜血管影为2.59个;平均肠系膜脂肪密度-98.57 HU;肠壁改变以单层为主.结论 对正常小肠MSCT的各种表现和测量指标的正确认识有助于小肠病变的诊断.     

Crohn's disease confined to the duodenum: A case report

Crohn’s disease (CD) can involve any part of the gastrointestinal tract from the mouth to anus. However, gastroduodenal CD is rare with a frequency reported to range between 0.5% and 4.0%. Most patients with gastroduodenal CD have concomitant lesions in the terminal ileum or colon, but isolated gastroduodenal Crohn’s disease is an extremely rare presentation of the disease accounting for less than 0.07% of all patients with CD. The symptoms of gastroduodenal CD include epigastric pain, dyspepsia, early satiety, anorexia, nausea, vomiting, and weight loss. The diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation. Here we report a rare case of isolated duodenal CD not confirmed by identification of granuloma on biopsy, but diagnosed by clinical evaluation.     

Predictors of necessity for endoscopic balloon dilatation in patients with Crohn’s disease-related small bowel stenosis

Background and AimIn patients with Crohn’s disease (CD) and small bowel stenosis, endoscopic balloon dilation (EBD) is considered to be useful in improving stenotic symptoms and avoiding surgery. However, it carries risks such as bleeding and perforation. The aim of this study was to identify the indications for endoscopic intervention in patients with CD and small bowel stenosis.MethodsFrom November 2007 to March 2020, 143 CD patients with small bowel stenosis were enrolled in this study. We identified the factors associated with not requiring endoscopic intervention during long-term follow-up of these patients.ResultsForty of the 143 patients had abdominal symptoms of stenosis and had undergone EBD, whereas the remaining 103 were asymptomatic and had not undergone endoscopic intervention. During long-term follow-up, 95 of those 103 patients never required endoscopic or surgical intervention. Multivariate logistic regression analysis revealed that not consuming an elemental diet (OR 3.18, 95% CI 1.48–6.82; p < .01) and ileocecal valve (ICV) stenosis (OR 0.30, 95% CI 0.11–0.83; p = .02) were independently associated with not requiring EBD. The cumulative emergency hospitalisation-free rate also tended to be higher in patients not consuming an elemental diet or with ICV stenosis.ConclusionsTwo factors, namely not consuming an elemental diet and ICV stenosis, predict a long-term intervention-free prognosis in CD patients with small bowel stenosis.

Key messages

• When an endoscopically impassable small bowel stenosis is found in a CD patient, long-term follow-up without endoscopic intervention may be possible if the patient is asymptomatic, is not using an elemental diet, and the stenosis is ICV.

     

超声诊断小肠T细胞淋巴瘤1例

患者男,64岁,主因"乏力、消瘦半年,发热半个月"入院.患者半年前无明显诱因出现乏力,消瘦,时而腹痛、恶心,近半年来体质量下降约14 kg;半个月前出现发热,伴咳嗽、寒战,体温最高达40℃,抗感染治疗效果差.查体:脐下及左下腹轻压痛,无反跳痛,未触及明显包块,移动性浊音(+),双下肢凹陷性水肿.超声于左上腹、中腹部及左下腹分别见直径约6.3 cm、12.0 cm及5.1 cm的肠管局限性增厚区(图1A),中腹部小肠增厚最为明显,厚度约1.7cm(图1B),增厚的肠管结构清晰,表现为黏膜层及黏膜下层包块,肌层受累不明显;肠管蠕动受限;左侧肠系膜可见多个肿大淋巴结,最大者约3.0 cm×2.4 cm.     

Bowel Sonoelastography in Patients with Crohn's Disease: A Systematic Review

Sonoelastography is an ultrasound-based method for evaluating the biological properties of a target tissue. It is commonly used in the diagnosis of liver and thyroid disease, but recently its use for monitoring the characteristics of bowel wall in patients affected by Crohn's disease (CD) has been proposed. Our aim was a systematic review of the use of sonoelastography in patients with CD. An initial database search retrieved 32 possible articles. On initial screening, 7 articles, concerning a total of 129 patients and 154 lesions of the small and large bowel, were finally included in the review. The age range varied between 6 and 53 y, and disease duration ranged between 1 and 623?mo. We collected data on the examinations performed (type and time), bowel area considered and parameters evaluated. All authors found that elastography correlates well with the degree of fibrosis, as wall strain significantly decreases in segments affected by fibrotic stenosis. Even though the endpoints proposed in the various articles are relatively inhomogeneous and scarcely comparable, we found that sonoelastography is a promising tool in the evaluation of patients with CD as it can differentiate inflammatory and fibrotic strictures in small case series.     

Pseudotumoral appearance of small bowel strictureplasty for Crohn's disease

In two patients with Crohn's disease, strictureplasties had been marked operatively by a metal clip, so that definitive location on subsequent small bowel examination was possible. Each stricture-plasty presented radiologically as a short annular constriction with apparently shouldered edges and parallel lumen. Similar radiological features were found in five other patients with strictureplasties, suggesting that a pseudotumoral appearance is characteristic of strictureplasty. Attention is drawn to this finding to avoid confusion with malignancy.     

Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.