胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄（44.2±14.6）岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性（Kappa值和P值）,并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例 而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%（19/19）,肠道清洁度优良率达79%（15/19）,检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

胶囊结肠镜对结肠黏膜炎症性改变的诊断价值初探

目的 探讨胶囊结肠镜下结肠黏膜损伤的内镜影像学特点对诊断溃疡性结肠炎的临床价值.方法 连续收集2009年7月至2010年6月间19例患者,其中男12例、女7例,平均年龄(44.2±14.6)岁,入组者以血便、腹泻、腹痛为主要临床表现,具备溃疡性结肠炎相关诊断依据.研究中将胶囊结肠镜和传统结肠镜下结肠黏膜病变严重程度分为轻、中、重三级,以传统结肠镜诊断为金标准,统计胶囊结肠镜与传统结肠镜下黏膜分级的一致性(Kappa值和P值),并同时观察胶囊结肠镜检查过程中肠道清洁度、全结肠检查完成率、患者不良反应等情况.结果 胶囊结肠镜下黏膜轻度病变2例,中度8例,重度9例;而传统结肠镜下则轻度3例,中度8例,重度8例.经统计Kappa=0.826,确切概率计算P＜0.001,提示一致性良好.胶囊内镜全结肠检查完成率达100%(19/19),肠道清洁度优良率达79%(15/19),检查全过程中未出现明显不良反应.结论 胶囊结肠镜能客观反映溃疡性结肠炎患者黏膜病变程度,具有部分替代传统结肠镜进行结肠病变监测的价值.     

胶囊结肠镜的临床应用

胶囊结肠镜（CCE）是一种检查结肠黏膜病变的新型胶囊内镜。最初用于结肠癌的筛查,目前逐渐用于炎症性肠病,尤其是溃疡性结肠炎的诊断和病情评估。CCE在临床应用方面与传统结肠镜相比各有优劣。本文就CCE的临床应用现状作一综述。     

结肠镜检查对缺血性结肠炎的诊断价值

目的探讨缺血性结肠炎的临床、内镜特点及早期诊断方法。方法35例缺血性结肠炎患者在腹痛症状出现后72h内行全结肠内镜及病理检查,并于首次检查后2周～2个月内复查结肠镜,部分病例取病变黏膜活检,观察其内镜下表现及临床病理特点。结果35例患者临床主要表现为腹痛、血便及腹泻等,病变全部位于左半结肠。一过性炎症型33例,狭窄型2例;病理学表现无特异性。结论早期行结肠镜检是诊断缺血性结肠炎的主要方法。     

猫抓样结肠

猫抓样结肠(CSC)是一种新近命名的内镜下特征性病变,病变于结肠镜检查中出现,好发于盲肠和升结肠,表现为红色、线形黏膜撕裂,发生机制被认为是结肠镜检查过程中肠腔内注气过多所致的结肠黏膜气压伤,并可能有其他机制合并参与。CSC病变可见于胶原性结肠炎、转流性结肠炎或合并其他非肠道原发疾病或状态。随着临床医师对该命名的认可,相关报道逐渐增加。本文通过复习现有相关文献,旨在更好地了解这一病变。     

结肠镜检查对于儿童下消化道疾病诊疗价值探讨

目的探讨儿童结肠镜检查的临床应用价值及安全性。方法对北京军区总医院2008年1月-2012年12月192例因腹痛、便血、腹泻、腹胀等症状就诊的患儿行结肠镜检查,并对患儿的临床资料进行分析。结果共129例患儿首次结肠镜检查完成全结肠镜检查,结肠镜检查完成率67.2%。32例患儿进镜过程中发现病变后退镜。病变部位主要为乙状结肠及直肠。病变主要为结肠息肉、结肠炎、过敏性紫癜、嗜酸粒细胞性肠炎、移植物抗宿主病、炎症性肠病等。91例便血患儿中61例发现大肠息肉。结论结肠镜检查及内镜下治疗对小儿肠道疾病诊断安全有效,并发症发生率低。小儿结肠病变常见部位为乙状结肠及直肠。小儿便血最常见原因为结肠息肉。     

结肠镜检前肠道清洁的准备方法

结肠镜是消化内科展开诊断、治疗的有效手段.结肠镜检查和内镜下治疗前必须先清洁肠道排除结肠内粪便,使结肠黏膜充分暴露,以便于操作和观察结肠黏膜的改变.结肠清洁的方法有多种,笔者对该院常用的3种方法进行了观察比较,以适用于不同类型的患者.报告如下.     

纤维结肠镜诊断结肠病变的探讨——附2275例分析

本文对2275例纤维结肠镜检查进行分析。结果,慢性结肠炎1299例(57.1％),结肠癌205例(9.0％),结肠息肉及息肉病283例(12.4％)以及溃疡性结肠炎,肠结核等病变。男女差别不大,以31—70岁成年人多见。本组全结肠检查成功率97.0％。纤维结肠镜对诊断结肠病变具有显著的临床意义。     

CT仿真结肠镜对结肠病变的临床应用探讨

目的 探讨结肠腺瘤。结肠癌,结肠憩室,溃疡性结肠炎,结肠黑变病等病变的ＣＴ仿真结肠镜表现,初步评价其在结肠病灶诊断中的应用价值。方法 ３７例病人（包括２０例结肠腺瘤,６例结肠癌,４例憩室,５例溃疡性结肠炎,结肠黑变病及结肠淀粉样变各１例）行ＣＴ仿真结肠镜并和结肠镜检查结果作对照,男２６例,女１１例,结果 ＣＴ仿真结肠镜对结肠癌和结肠腺瘤、结肠憩室有较高的辨别率,成功地检出了６例结肠癌、１７例结肠腺     

甘露醇潜水胶囊内镜在小肠疾病诊断中的应用

目的改善胶囊内镜在小肠检查过程中肠道准备情况,提高图像清晰度,提高小肠疾病的检出率。方法回顾性分析2019年1月至2019年11月我院进行胶囊内镜检查的100例患者的临床资料,其中行传统胶囊内镜患者50例(潜甘露醇组),行潜甘露醇胶囊内镜患者50例(传统组)。比较两组检查完成率和胶囊在小肠通过时间,小肠清洁度及黏膜充盈程度,小肠病变检出率等指标。结果潜甘露醇组小肠病变检出率为72%,显著高于传统组的34%(P 0. 01)。在潜甘露醇组的小肠通过时间较传统组的明显缩短(P 0. 05)。潜甘露醇组的小肠黏膜清洁度评分、小肠充盈度评分均显著优于传统组(P 0. 01)。结论潜甘露醇胶囊内镜可改善胶囊内镜的检查效率及诊断率,是一种行之有效的小肠疾病检查方法。     

Colonic mucosal hemodynamics and tissue oxygenation in patients with ulcerative colitis: Investigation by organ reflectance spectrophotometry

Colonic mucosal hemodynamics were investigated at the rectosigmoidal region of the colon in 46 patients with ulcerative colitis and in 18 normal subjects by organ reflectance spectrophotometry under colonoscopy. The value for the index of mucosal hemoglobin concentration (IHb) was significantly higher, and value for the index of mucosal hemoglobin oxygen saturation (ISO₂) was significantly lower in patients with active ulcerative colitis than values in the normal controls or in patients with inactive ulcerative colitis. The results indicate mucosal congestion and hypoxemia in patients with active ulcerative colitis. The changes in IHb and ISO₂ correlated well with the severity of ulcerative colitis scored by endoscopic findings and with the number of infiltrating inflammatory cells in the mucosa analyzed histologically in biopsy samples. In conclusion, the colonic mucosal microcirculation in patients with active ulcerative colitis was disturbed and showed congestion and hypoxemia. The analysis of hemodynamic changes may be helpful for assessing the activity of ulcerative colitis.     

Morphological study on colonic pathology in ulcerative colitis treated by moxibustion

AIM:To observe the therapeutic effect of moxibustion on ulcerative colitis and its influence on the colonic mucosal morphology.METHODS:Forty-six patients with ulcerative colitis were randomly divided into the moxibustion with herbal medicine underneath group and the western medicine group. Thirty patients were treated with the above moxibustion and 16 patients with Salicylaye fapyridine (SASP).The colonic mucosa of 13 patients in the moxibustion group was observed by colonoscopy before and after the treatment. Mucin was also analyzed by H.E and AB-PAS staining.RESULTS:Seventeen patients were clinically cured,12 were improved and 1 unchanged in the moxibustion group. In the control group, 5 patients were clinically cured,7 improved and 4 unchanged. Thirteen patients with active UC were taken as the subjects for histopathologic analysis in this study. The colonic mucosal lesions were remarkably improved and the characteristic of the mucin also changed. In most sections, the chronic inflammation of mucosa was geatly ameliorated (P< 0.01). The inflammatory cell infiltratation much decreased and neutrophils, disapeared in most sections (P<0.001). The goblet cells significantly increased (P<0.001); crypt paracrypt abscess or mucosal ulceration was seen(P<0.001).CONCLUSION:The rate of cure of ulcerative colitis by moxibustion with herbal medicine beneath is superior to that by SASP. This sort of moxibustion can effectively improve the colonic mucosal lesions and restore the proportion of mucoprotein to near normal.     

Phospholipase A2 activity of colonic mucosa in patients with ulcerative colitis.

Activation of enzyme phospholipase A2 (EC 3.1.1.4), the major liberator of arachidonic acid, has been proposed as a component in the pathogenesis of inflammatory bowel disease. To test the hypothesis that phospholipase A2 activity is increased in ulcerative colitis, enzyme activity was investigated in colonic biopsies using radiolabelled Escherichia coli as substrate. The study comprised patients with ulcerative colitis (n = 19) and controls without inflammatory bowel disease (n = 7). Ulcerative colitis patients were grouped into those with active disease (n = 8) and those in remission (n = 11) at the time of colonoscopy. No differences were found in mucosal phospholipase A2 activity between patients with active disease, patients in remission and controls. With the present assay we were unable to demonstrate activation of phospholipase A2 as a mechanism in the inflammatory process of ulcerative colitis.     

DNA flow cytometric evaluation of cell cycle distribution in ulcerative colitis: a proposed method for assessing severity of disease.

The assessment of disease severity in ulcerative colitis depends mainly on subjective variables, and an objective method of assessing mucosal inflammation is needed. Determination of the synthetic phase of the cell cycle is an accurate expression of inflammatory activity in the colonic mucosa. The aim of the study was to find out if the proliferative index or the synthetic phase (S phase) of the colonic mucosa of patients with ulcerative colitis, as evaluated by DNA flow cytometry, is a reliable and reproducible marker of disease activity. Sixty consecutive patients with ulcerative colitis of different degrees of activity were entered into the study and submitted to colonoscopy plus multiple rectal biopsies. Disease severity was defined for each patient by means of a clinical, endoscopic, and histological score. Flow cytometry was used to calculate the proliferative index and the S phase of the cell cycle. A statistically significant correlation (p < 0.001) was found between all indices of severity. It is suggested that flow cytometric evaluation of the cell cycle in the rectal mucosa may be an efficient method of assessing severity of disease and efficacy of medical treatment in ulcerative colitis.     

Colon capsule endoscopy for inflammatory bowel disease

Colon capsule endoscopy (CCE) is designed for direct visualization of the colonic mucosa through passive propulsion. The role of CCE in the detection of colonic polyps has been extensively evaluated. As mucosal healing has emerged as a pivotal target for treatment of inflammatory bowel disease (IBD), there is increasing data to suggest that CCE can also be used in the monitoring of mucosal inflammation in patients with active IBD, particularly in ulcerative colitis (UC) and Crohn's disease (CD). Despite advantages such as its non‐invasive nature, patient's comfort, safety, and access to anatomical regions not easily reached by conventional endoscopy, CE has limitations including the lack of ability to obtain biopsies or therapeutic capabilities and no control over movement. In this review, the role and diagnostic value of CCE on diagnosis and monitoring of UC and CD patients, its safety and limitations are discussed.     

Protection by recombinant human interleukin-11 against experimental TNB-induced colitis in rats

The potential effect of recombinant human interleukin-11 (rhIL-11) on trinitrobenzene sulfonic acid (TNB) -induced colitis was investigated in rats. Intrarectal TNB (40 mg in 0.25 ml 40% ethanol) produced significant ulcerative colitis. The lesions were most severe at three days after TNB instillation, and then declined, but lesions were still observed after two weeks. TNB administration also significantly enhanced the colonic mucosal myeloperoxidase (MPO) levels, which paralleled the severity of colitis. The rhIL-11 at subcutaneous doses of 300 or 1000µg/kg daily for seven days, or 1000µg/kg for three days when given after TNB significantly decreased lesion formation in TNB-induced colitis. These treatments also significantly reduced colonic mucosal MPO levels. TNB enhanced colonic mucosal levels of PGE₂, LTB₄, and TxB₂, but these arachidonic acid derivatives were not affected by the present rhIL-11 treatments. TNB administration for three days caused a body weight loss that returned to normal after 14 days. The rhIL-11 significantly reduced colonic lesion severity and reduced colonic fecal blood loss. Given alone, rhIL-11 did not influence body weight. It can be concluded that rhIL-11 was protective against TNB-induced colitis and reactions of colonic MPO, but that these responses were not mediated through modulation of eicosanoid metabolism.Supported by Genetics Institute, Inc., Andover, Massachusetts.