小儿克隆病的诊断与治疗

克隆病 (Ｃｒｏｈｎ’ｓｄｉｓｅａｓｅ)是胃肠道慢性炎性肉芽肿性疾病 ,可累及肠壁全层 ,它可以发生在消化道的任何部位 ,但以回盲部常见。其病因尚不清楚 ,诊断和治疗仍然是一个难题。因为其病情有轻有重 ,临床表现无特异性 ,大部分患儿直到出现发热、穿孔、出血或生长发育停滞等 ,才得到确诊。因此作为临床医生 ,了解克隆病的临床表现及治疗原则 ,对早期确诊和正确治疗及预防严重并发症的发生极其重要。1　克隆病的诊断目前尚无诊断克隆病的可靠实验诊断方法 ,确诊主要依赖于患儿的临床及病理表现。1 1　临床表现　克隆病最常见的临床症…     

胶囊内镜在儿童克罗恩病中的诊断价值

目的探讨胶囊内镜在儿童小肠克罗恩病中的诊断价值及安全性。方法回顾性分析2003年1月至2010年4月经胶囊内镜检查的25例克罗恩病患儿临床资料,分析其临床表现、胶囊内镜检查完成情况、镜下特点及诊断情况。结果 25例克罗恩病患儿共行26次胶囊内镜检查,均顺利吞下胶囊内镜,其中21例在工作时间内到达回盲瓣,过瓣率80.8%(21/26);21例经胶囊内镜诊断克罗恩病,主要表现为阿弗他溃疡,环状或裂隙样溃疡。所有病例均无胶囊内镜梗阻发生。结论胶囊内镜在诊断儿童克罗恩病中安全,较其他影像学检查诊断率高,尤其是对累及小肠的克罗恩病,胶囊内镜下表现特异。     

Crohn's disease in children and adolescents

93 children and adolescents with Crohn's disease have been studied. Terminal ileum (25.8%) and ileum and colon (61.3%) were the most common sites of involvement as determined by X-ray examination. The mean age at the time of diagnosis was 13.2 years. A familial incidence of chronic inflammatory bowel disease was found in 12 patients (12.9%). The most common symptoms were: abdominal pain, anorexia, lassitude, diarrhea, loss of weight. Weight below the third percentile, pain on abdominal palpation, anal lesions, mouth ulcers and clubbing of the fingers were the most common clinical signs at the time of diagnosis. Growth retardation (below the third percentile) was present in 22 of 79 children (27.8%) with a mean follow-up of 40 months. 16 patients out of 75 had initial rectal biopsies with histologic changes characteristic of Crohn's disease. 27 patients had surgical treatment; six of them experienced a relapse within a mean period of 26.7 months. Lastly, the authors show that continuous elemental enteral alimentation (CEEA) during 3 weeks induces a remission. CEEA on a longer period is specially targetted to the treatment of growth retardation.     

Intestinal tuberculosis and differential diagnosis against Crohn's disease in children (author's transl)

The case of a 9-year-old girl treated elsewhere for anemia due to iron deficit is described. The first diagnosis of Crohn's disease made by us and for which the girl received treatment had to be revised, because an intestinal tuberculosis was later accepted to be the correct diagnosis. The authors emphasize the importance of safe diagnostic distinctions between Crohn's disease and intestinal tuberculosis. Diagnostic and therapeutic procedures are discussed.     

Laparoscopy for Crohn's disease in children

Traditionally, the diagnosis of Crohn's disease is established by colonoileoscopy and radiology. With these techniques the main area of interest, the distal ileum, is not easily reached. Also, the outer aspect of the bowel is ignored and there is no appreciation of the involvement of other intra-abdominal organs. Laparoscopy provides additional information. This may establish a more precise diagnosis, better standardization in comparative studies, and more specific therapy. Accepted: 6 November 1997     

Endocrine dysfunction in children with Crohn's disease

A series of 14 children with Crohn's disease and growth retardation was screened for endocrine dysfunction. Four children presented with growth failure. All had normal cortisol responses to insulin-induced hypoglycaemia. Ten children had normal growth hormone responses in the same test, while four had abnormal responses. Gonadotrophin responsiveness to luteinizing hormone releasing hormone (LHRH) paralleled the clinical evidence of puberty, or its lack. Serum total thyroxine was normal in every patient, while serum total triiodothyronine was low in six; in these six patients serum triiodothyronine normalised with treatment. Serum folate was subnormal in 13 patients and the erythrocyte sedimentation rate was elevated in all at the time of diagnosis. Our results demonstrate a spectrum of endocrine changes seen in children with Crohn's disease, particularly prepubertal gonadotrophin responses to LHRH and a relative preservation of growth hormone and cortisol responsiveness to hypoglycaemia, with a defect in thyroxine to triiodothyronine conversion in severely ill children. Serum folate and sedimentation rate may be useful screening tests for Crohn's disease in a child presenting with failure of growth.     

结肠镜及组织学检查对儿童克罗恩病的诊断价值

目的 探讨结肠镜诊断儿童克罗恩病的重要性及活检组织学检查的价值.方法 回顾性分析近10年诊治的10例克罗恩病患儿结肠镜下特点及活检组织学特点,分析其诊断价值.结果 10例克罗恩病患儿中,小肠结肠型6例.结肠型1例,小肠型3例.累及结肠7例中结肠镜下全结肠累及者2例(28.5%),左半结肠、右半结肠或横结肠累及者各3例(42.9%),乙状结肠、回盲部累及者各2例(28.5%),直肠累及者1例(14.3%).结肠镜下表现有节段性分布、溃疡多样性、修复性改变、部分肠管狭窄僵硬等特点.活检组织学以淋巴细胞浸润多见,肉芽肿检出率28.5%.结论 结肠镜检查在克罗恩病诊断中有重要意义,常规结肠镜下活组织学检查缺乏特异性,可多部位、深凿活检以提高阳性率.     

小儿克罗恩病一家3例

患儿,女,5.5月,入院主诉为腹泻4月余,脓血便2月。该患儿生后12d开始腹泻,以后有脓血便伴进乳后呕吐,时有发热,易出现口腔溃疡,皮肤结节红斑,偶有腹胀,常哭闹不止,伴明显消瘦,少尿。门诊超声提示乙状结肠增宽,便常规示脓血粘液便。患儿系足月顺产,第3胎第3产,发育迟缓,不能翻身、坐,平素易患口腔溃疡、皮肤脓疮。     

Clinical features of gastroduodenal Crohn's disease in adolescents

Ten cases of gastroduodenal inflammation were diagnosed by endoscopy among a series of 196 children with evidence of Crohn's disease involving other regions of the intestinal tract. Endoscopic and histologic confirmation of upper gastrointestinal tract involvement was performed only in those cases with suggestive symptoms. The mean age at presentation in the 10 cases with gastroduodenal inflammation was 14.6 +/- 1.9 (+/- SD) years, with involvement identified at the time of initial diagnosis of Crohn's disease in five of the 10. Eight of 10 cases occurred in boys. The major presenting symptoms were weight loss in five cases, epigastric pain in three, and recurrent vomiting in two. Hematemesis and melena occurred in only one of the 10 cases. Endoscopic and histological evidence of mucosal inflammation was seen in all 10 cases. Three of 10 cases had noncaseating granuloma present in biopsies of the stomach or duodenum. Two cases also had endoscopic and histological evidence of esophageal involvement. All cases were initially treated with oral corticosteroids, and in each instance a good clinical response was noted. Sucralfate (n = 1), 6-mercaptopurine (n = 1), and H2 receptor antagonists (n = 3) were used as adjunct therapy. After follow-up for 2.7 years (range, 0.5-5.5 years), none of the 10 cases required surgical intervention. Therefore, at least in the short-term, the outlook for adolescents with gastroduodenal Crohn's disease appears to be good and their medical management need not differ from those patients with Crohn's disease involving only more distal portions of the small intestine.     

Isolated bifid rib: Clinical and radiological findings in children

Background: Bifid rib is usually asymptomatic but sometimes occurs associated with other pathological conditions. The aim of this study was to investigate clinical and radiological characteristics in children with bifid rib. Methods: Nine children with the diagnosis of bifid rib between 2005 and 2010 were reviewed. Chest radiography and computed tomography (CT) were performed in all patients, and 3‐D images were additionally reconstructed in six patients. Results: Five girls and four boys with a mean age at presentation of 4.2 years had various types of unilateral bifid rib. Seven patients complained of a chest wall mass, whereas two patients whose costal abnormalities were incidentally detected on chest radiography were asymptomatic. Bifid ribs were confirmed on plain radiographs in six patients, while the other three patients were finally diagnosed on reconstruction 3D‐CT. One patient with a flared rib on a radiograph showed bifurcation of the costal cartilage on 3D‐CT. The other two patients with upper rib abnormalities on radiography had downward extension of the cervical or first rib articulating with the upper branch of the bifid first or second rib, respectively. Conclusion: Reconstruction 3D‐CT can demonstrate complicated thoracic abnormalities in patients with atypical appearance of the rib on plain radiographs. An isolated bifid rib may require no further intervention.