儿童克罗恩病10 例临床分析

目的 探讨儿童克罗恩病（CD） 的临床特点,并对其治疗进行初步探讨。方法 回顾性分析2005 年1 月至2013 年12 月间10 例确诊为CD 患儿的临床资料,包括其临床表现、内镜表现及内镜下黏膜活检病理特点、腹部B 超、实验室检查结果及治疗情况等。结果 患儿临床表现以腹痛、腹泻、便血为主,多伴有不同程度的生长发育障碍及营养障碍,肠外表现以发热为主。肠镜检查常见表现为非连续性阶段性黏膜充血、糜烂、黏膜呈鹅卵石样增生病变、黏膜溃疡等。腹部B 超检查示肠壁的不均匀阶段性增厚。病理表现主要为固有膜内较多淋巴细胞、嗜酸性粒细胞、浆细胞浸润,黏膜腺体部分萎缩。疾病缓解期CRP 明显低于急性发作期及疾病复发期（PP结论 儿童CD 的临床表现及实验室检查均缺乏特异性。ESR 及CRP 可作为疾病进展评估的指标。5-ASA 在儿童CD 的诱导和维持缓解中有一定的疗效。治疗转归与疾病初期PCDAI 评分的高低有一定的相关性。     

小肠镜和组织活检对儿童慢性腹泻病的诊断价值

目的 评价小肠镜和活体组织病理、超微病理检查对儿童慢性腹泻病的诊断价值.方法 华中科技大学同济医学院附属同济医院儿科病房2005年2月至11月应用小肠镜和活体组织病理、超微病理检查明确诊断的3例慢性腹泻病患儿,对其临床表现、辅助检查、治疗方案及预后进行回顾性分析和总结.结果 3例患儿均表现为长期反复腹泻.其中1例IgA水平异常增高、1例明显低蛋白血症.患儿均予小肠镜检,诊断分别为免疫增生性小肠病、原发性小肠淋巴管扩张症和异位内分泌性腹泻,2例病理、超微病理检查结果具有特异性.3例患儿均予营养支持治疗,1例四环素疗效明显,1例奥曲肽治疗有效,l例补液治疗即好转.结论 小肠性慢性腹泻病诊治困难,小肠镜和活体组织病理、超微病理检查有助于提高儿童慢性腹泻病的诊治水平和深化对小肠疾病发病机制的认识.     

儿童乳糜泻 2 例临床分析

目的探讨儿童乳糜泻的诊断及治疗。方法回顾分析2例乳糜泻患儿的临床资料。结果 2例患儿均为男性,分别为8岁、2岁,均以慢性腹泻、营养不良为主要表现,合并有贫血、低白蛋白血症。大便苏丹Ⅲ染色阳性,抗肌内膜抗体Ig A、抗麦胶蛋白Ig A阳性。内镜检查发现十二指肠及小肠黏膜病变;病理均提示小肠绒毛萎缩,隐窝上皮内淋巴细胞浸润,黏膜固有层中多量淋巴细胞及浆细胞浸润。2例患儿给予避免麸质饮食后腹泻很快好转,体质量明显增加。但其中1例未能坚持免麸质饮食,腹泻出现反复。结论儿童乳糜泻在中国少见,需早期诊断及治疗,应严格终生无麸质饮食。     

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。     

54例儿童克罗恩病肠外表现和肠道并发症分析

目的 总结克罗恩病（CD）患儿的肠外表现和肠道并发症，以期为儿科医师更全面地认识儿童CD提供帮助。方法 收集2008年1月至2018年12月期间诊断为CD的54例患儿的临床资料，依据病变部位可分为回结肠型30例，回肠型18例，结肠型6例，回顾性分析患儿的肠外表现及肠道并发症。结果 54例CD患儿中，诊断时年龄为14.5±2.7岁，自起病至明确诊断的中位病程为20（1~36）个月。24例CD患儿（44%）有肠外表现，以生长迟缓（11例，20%）和口腔黏膜溃疡（10例，19%）最为常见，其次为关节炎（2例，4%），结节性红斑（2例，4%），胆囊炎（2例，4%）。回肠型、结肠型及回结肠型患儿之间肠外表现发生率比较差异无统计学意义（P=0.792）。肠道病变相关的并发症最常见为肛瘘或肛周脓肿（13例，24%），其次为肠瘘（5例，9%）和肠梗阻（4例，7%）。回肠型、结肠型及回结肠型患儿之间肠道并发症发生率比较差异有统计学意义（P=0.041），且结肠型病例中未见到有患儿合并肠道并发症。结论 儿童CD肠外表现及肠道并发症较为多见，需提高对儿童CD肠外表现及肠道并发症的认识，加强系统管理，疑诊CD时重视肛周检查。结肠型CD患儿可能病情较缓和，更少发生肠道并发症。     

儿童隐源性多灶性溃疡性狭窄性小肠炎1例并文献复习

目的：报道1例儿童隐源性多灶性溃疡性狭窄性小肠炎（CMUSE）的临床特点,提高对该罕见病的认识。方法：总结1例儿童CMUSE的临床特点、实验室检查、影像学检查及内镜下表现、病理特征和诊疗经过。并行文献复习,总结CMUSE的临床表现及预后。 结果：男,9岁6个月,因“反复贫血伴黑便6年”就诊。患儿3岁多出现口唇苍白,以“缺铁性贫血”治疗效果欠佳,后相继出现反复柏油样便和腹痛,住院查炎症指标正常,胃镜和结肠镜检查未见异常,胶囊内镜示小肠多发环形狭窄伴溃疡,组织病理学未见特异性表现,诊断为CMUSE。予强的松龙和硫唑嘌呤口服,复查胶囊内镜,病变明显好转。目前随访8个月,患儿无复发。文献复习发现CMUSE好发于中青年,18~50岁占68.6%（35/51）。就诊前平均病程9.9年。CMUSE发病早期以腹痛（67.9%）、贫血（32.1%）和消化道出血（18.5%）为主要表现。胶囊内镜滞留率37.9%,再手术率29.7%。结论：不明原因的反复黑便、贫血伴发小肠溃疡和狭窄性病变时需考虑CMUSE。内镜检查的诊断价值较高。糖皮质激素治疗有效,但易复发,预后欠佳。     

胶囊内镜在儿童小肠疾病诊治中的应用价值

目的 对疑有小肠疾病的儿童进行胶囊内镜检查,评估胶囊内镜在儿科的应用价值以及安全性.方法对2004年6月-2008年6月疑有小肠疾病的住院和门诊儿童43例进行胶囊内镜检查,男28例,女15例,年龄6～18岁,体重15～60 kg,身高110～180 cm,观察胶囊内镜检查成功率和失败率、胶囊内镜通过胃、小肠的平均时间,病变检出率和与最终诊断的符合率,操作过程中患者的耐受性和并发症;由胶囊内镜传送图像的质量评价;禁食8 h后检测时小肠的清洁度.结果 所有患儿均顺利吞服胶囊,检查期间耐受性好.共进行胶囊内镜检查46例次,成功43例次,失败3例次(成功率94%);胶囊内镜通过胃的平均时间为73(3～600)min,小肠内平均运行时间为246(73～413)min;检出病变37例(90%),与最终诊断符合的为31例(84%),出现并发症1例(2%);禁食8 h,小肠的清洁度佳,胶囊内镜所获取图像质量良好.结论 对于儿童不明原因的小肠疾病,特别是不明原因的小肠出血和小肠克罗恩病的诊断,胶囊内镜是一种安全和有效的检查方法.     

胶囊内镜对儿童小肠疾病诊断价值研究

摘要：目的　评价胶囊内镜检查在儿科应用的有效性和安全性。方法　对2007年9月至2010年12月福建医科大学附属漳州市医院28例临床疑诊小肠疾病的患儿进行胶囊内镜检查。观察胶囊内镜通过胃的平均时间、通过小肠的平均时间、成功率和失败率、小肠病变检出率及患儿的耐受性和并发症。结果　28例患儿均成功吞服胶囊内镜并完整排出,检查过程患儿耐受良好。胶囊内镜通过胃的时间20～280 min（中位数64 min）,通过小肠的时间93～380 min（中位数255 min）,检出病变20例（20/28,71.43%）。结论　对疑诊小肠疾病,胶囊内镜检查是的一种有效和安全的方法。     

克罗恩病22例的早期诊断

目的 研究小儿克罗恩病(CD)临床表现的多样性及其诊断。方法 对22例克罗恩病临床特征、内镜表现及实验室检查结果进行分析。结果 发病以青春期儿童为主，主要临床表现为发热、腹痛，其次为便血，部分可有厌食、体重下降、生长发育迟缓、贫血、肛门病变及复发性口腔黏膜溃疡等表现。结肠镜检查病变呈跳跃式分布，肠黏膜充血、水肿，可见溃疡，肠腔狭窄及卵石样改变。全消化道造影及B超检查也可提示相应部位病变。结论 小儿克罗恩病临床表现多样，缺乏特异性，重视体重减低、口腔溃疡、肛周病变、贫血等多系统表现，采用综合诊断方法，有助于早期正确诊断。     

小儿胃肠道肿瘤及瘤样病变126例内镜分析

目的：探讨内镜检查对小儿胃肠道肿瘤及瘤样病变诊治的临床意义。方法：近10年应用小儿内镜对357例患儿进行检查。结果：小儿胃肠道息肉122例,血管瘤2例,直肠癌1例,贲门癌1例。内镜下切除息肉274颗(息肉残蒂3颗)。结论：内镜检查是诊断胃肠道肿瘤及瘤样病变最直观、有效及安全的方法,部分良性病变可镜下治疗。     

儿童炎症性肠病临床及结肠镜下特点分析

目的 探讨儿童炎症性肠病的临床特点,分析结肠镜及活组织学检查对疾病诊断的重要性.方法 研究在我院住院的34例炎症性肠病患儿的临床表现、实验室检查、结肠镜下特点及活检组织学特点,分析其诊断价值.其中克罗恩病(CD)10例,溃疡性结肠炎(UC)24例.结果 CD组中,轻-中度活动型4例,重度活动型6例.临床表现以腹痛多见(80%,8/10);并发症:肠穿孔1例,肠梗阻2例,肛瘘2例.UC组中,轻度5例,中度14例,重度5例.临床表现以腹泻为主(23/24,96%);肛周疾病3例,并发慢性肠套叠1例.CD组血沉、C反应蛋白水平较UC组高(X2=15.938、11.184,P均<0.01).10例CD中,小肠结肠型6例(60%),结肠型1例(10%),小肠捌3例(30%).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.24例UC中,全结肠累及者6例(25%),乙状结肠、直肠累及者14例(58%),左半结肠累及者7例(29%),结肠镜下表现为连续性黏膜充血水肿、糜烂,多发浅溃疡多见,溃疡多不规则,7例(29%)可见假息肉形成,黏膜桥未见.CD活检组织学均有淋巴细胞浸润,1例见裂隙状溃疡,2例见上皮性肉芽肿.UC活检标本均有多量中性粒细胞、淋巴细胞、浆细胞等炎性细胞浸润表现,其中4例(17%)见隐窝脓肿.结论 儿童炎症性肠病的临床特点具有非特异性,结肠镜结合组织活检对UC的诊断有可靠的价值.对于结肠型或小肠结肠型CD,结肠镜检查有重要意义,组织活检特异性不高,可多部位、深凿活检以提高阳性率,协助诊断.     

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.     

双气囊小肠镜在儿科患者中的应用

目的 探讨双气囊小肠镜在儿童中的使用方法、安全性,评价其临床价值,及其在儿科应用的困难.方法 本组22例,为2006年12月至2009年10月在我院消化科住院,因为胃肠道出血、再发性腹痛、低蛋白血症等原因接受双气囊小肠镜检查患儿,年龄4～16岁,所有操作均在麻醉下进行,患儿均取仰卧位,利用双气囊小肠独有的外套管、肠镜前端的双气囊交替充气、放气,经幽门或回盲瓣进入小肠,小肠镜和外套管不断地前进和退镜,将小肠缩短到内窥镜可以检查的范围.在检查过程中记录检查范围、病变,患儿耐受性等.结果 本组共接受25例次双气囊小肠镜检查,其中3例次顺行进镜,22例次逆行进镜;3例同时经口和经肛门检查.18例发现病灶,病变检出率为81.82%.所有操作均在麻醉下进行,包括麻醉和术后恢复,一般需要90～120 min.本组均未发生吸入性肺炎、肠道穿孔、出血等严重并发症.通过双气囊小肠镜,诊断克罗恩病7例,Meckel憩室并溃疡3例,空肠、横结肠息肉1例,小肠淋巴管扩张症1例、阿米巴肠炎1例、小肠炎出血3例,非特异性回肠炎2例.本组均耐受检查,未发现严重不良反应和并发症.结论 双气囊小肠镜对小肠疾病有良好的检出率,儿童患者能耐受检查,在儿科患者中应用是有效和可行的.但双气囊小肠镜在儿科的推广应用仍受到一些因素的制约.     

Evaluation of oral budesonide for treatment of mild and moderate exacerbations of Crohn's disease in children

OBJECTIVES: Oral budesonide has been found to be efficacious for mild to moderate Crohn's disease in adults, with equal improvement rates for budesonide and prednisone. We report the results of a retrospective study of budesonide treatment in mild to moderate Crohn's disease in children. STUDY DESIGN: Charts of patients treated with budesonide (n = 62) with a pediatric Crohn's Disease Activity Index of 12.5 to 40 were compared with a cohort of 58 age-matched patients treated with prednisone. RESULTS: Among children treated with budesonide, 48% had remission compared with 77% of the children treated with prednisone (P =.001). Among patients who had failed previous medical therapy with mesalamine, 59% had remission with budesonide (9 mg/day). Remission with prednisone occurred in 73% of children who failed to achieve remission with budesonide. Patients responding to budesonide had significantly milder disease compared with nonresponders who had remission while taking prednisone. CONCLUSIONS: Budesonide is useful in mild to moderate Crohn's disease in children. It is more effective than mesalamine and antibiotics but less effective than prednisone. Budesonide should be considered for first-line therapy in mild to moderate Crohn's disease.     

Utility of capsule endoscopy in pediatric gastroenterology

Wireless endoscopy is a new noninvasive diagnostic method that is able to visualize small bowel lesions. The instrument is small and carries a battery and microcamera that takes two photographs per second. It is indicated in cases of bleeding of unknown origin and for the diagnosis of inflammatory bowel disease, among other disorders. To date, it has mainly been used in adults. We believe that this instrument could play an important role in the pediatric age group since it is noninvasive and can be used to diagnose small bowel lesions, thus avoiding unnecessary diagnostic tests. We report the case of a girl with suspicion of Crohn's disease that was unconfirmed by conventional endoscopic techniques. The capsule showed small bowel lesions compatible with Crohn's disease. Corticosteroid treatment was initiated and the patient is now in clinical remission.     

青少年炎症性肠病伴生长激素缺乏4例并文献复习

炎症性肠病（IBD）为慢性复发性非特异性肠道炎症性病变,10%~56%的克罗恩病患儿和10%左右的溃疡性结肠炎患儿存在生长迟缓。该研究报道4例伴生长激素缺乏的青少年IBD（均为克罗恩病）,其中男3例、女1例,确诊年龄11.0~13.9岁,确诊时病程11~85个月。4例患儿的病灶分别为：单纯小肠、单纯结肠、小肠及上消化道、小肠及结肠均累及,克罗恩病活动指数27.5~45分。4例患儿的年龄别身高Z评分（HAZ）均 < -2,生长激素刺激试验均提示生长激素缺乏症。2例患儿接受了重组人生长激素联合英夫利西单抗治疗,1例仅接受英夫利西单抗治疗,另1例接受重组人生长激素联合巯嘌呤的治疗。所有患儿经治疗后HAZ评分均有改善。     

Inflammatory disease of the colon: ulcerative colitis and Crohn's colitis.

Ulcerative colitis differs from Crohn's colitis in several ways. In ulcerative colitis the disease is limited to the mucosa and, occasionally, the submucosa; Crohn's colitis may involve all layers of the large intestine. Ulcerative colitis almost always begins in the rectum, is diffuse, and spreads proximally. Crohn's colitis may spare the rectum and has a patchy distribution. Perianal fistulas and ulcers are rare in ulcerative colitis but are common in Crohn's colitis. Granulomas and giant cells are not found in ulcerative colitis but are seen in the majority of patients with Crohn's colitis. Colonic and extraintestinal symptoms in the two illnesses may be indistinguishable but growth failure is far more severe in Crohn's colitis and may precede intestinal symptoms by months to years. Cancer of the colon is a risk in patients with either ulcerative or Crohn's colitis but is far more common in the former. It is important to distinguish between ulcerative colitis and Crohn's colitis because response to treatment and prognosis are different. Although neither condition can be cured by medical management, patients with ulcerative colitis may respond more frequently. Unfortunately, in the pediatric age range most cases of ulcerative and Crohn's colitis may be classified as moderate to severe. Fortunately for patients with ulcerative colitis, total colectomy with ileostomy will result in cure of illness. Patients with Crohn's colitis who require surgery may obtain remission of symptoms, but the disease is likely to recur in the small intestine.     

Magnetic resonance imaging to distinguish the type and severity of pediatric inflammatory bowel diseases

BACKGROUND: The distinction between ulcerative colitis and Crohn's disease is important, because treatment options and clinical course may vary. Magnetic resonance imaging (MRI) allows noninvasive transmural assessment of the intestine and may facilitate differentiation of ulcerative colitis from Crohn's disease. The objective of this prospective study was to determine whether MRI differentiates Crohn's disease from ulcerative colitis in children as effectively as colonoscopy with mucosal biopsies. METHODS: Fifteen patients underwent colonoscopy with biopsies followed by abdominal MRI. The MRI diagnosis, determined by two radiologists independently completing a standardized form was compared with the gastroenterologic diagnosis. RESULTS: After colonoscopy and review of histology, Crohn's disease was diagnosed in nine patients, ulcerative colitis in five, and indeterminate colitis in one, who was excluded from study. Agreement of the MRI diagnosis with the gastroenterologic diagnosis was 4 of 4 (100%) for ulcerative colitis, 4 of 10 (40%) for Crohn's disease considering both radiologists, and 5 of 10 (50%) for Crohn's disease for each radiologist individually. Percentage of enhancement by MRI did not correlate with the severity of inflammation determined at endoscopy among the patients with Crohn's disease (r = -0.3, P = 0.366). There was agreement on severity of inflammation in three of four patients with ulcerative colitis. CONCLUSIONS: Current MRI interpretation of inflammatory bowel disease did not adequately recognize Crohn's disease in children. Therefore, colonoscopy with biopsy remains the most accurate tool for determining the type and severity of inflammatory bowel disease in children and adolescents.