内镜及活检病理对回盲部溃疡的鉴别诊断

目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡，结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌（溃疡型）进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断；对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明：异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义（P〈0．05）；单纯类上皮结节（即结节样肉芽肿）见于克罗恩病和肠结核病，若未发现肠结核干酪样坏死，两者不易鉴别；隐窝脓肿多见于溃疡性结肠炎，但该病理特征诊断意义不强，可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的，综合分析其结果可进一步提高诊断准确率。     

炎症性肠病诊断与治疗的共识意见(2012年·广州)病理诊断部分解读

炎症性肠病(IBD)是一组病因尚不十分清楚的慢性非特异性肠道炎症性疾病,包括溃疡性结肠炎(UC)和克罗恩病(CD)。UC在病理学上可表现为黏膜糜烂、浅溃疡、固有膜内重度弥漫性急性、慢性炎性细胞浸润、隐窝脓肿等,但缺乏特征性改变;CD可有透壁性炎症、裂隙状溃疡/阿弗他溃疡、非干酪样坏死性肉芽肿、神经节细胞增生等改变,但亦无诊断金标准。因此,UC和CD的确诊均不能单纯依靠病理检查,尤其是黏膜活检标本病理检查,而需结合临床、内镜、影像学和组织病理学表现进行综合分析并随访观察,在排除感染性和其他非感染性结肠炎的基础上作出诊断。     

内镜及病理学检查在克罗恩病和肠结核鉴别诊断中的价值

目的 评价内镜及组织病理学检查在克罗恩病和肠结核的鉴别诊断中的价值。方法 回顾性复习经手术证实的克罗恩病和肠结核各30例资料，对其临床、内镜表现、手术记录等进行分析，并重新审读病理切片。结果 内镜诊断克罗恩病的灵敏度、特异度和准确性分别为80．0％、25．6％和49．3％，而在肠结核中的灵敏度、特异度和准确性分别为86．7％、46．2％和63．8％。克罗恩病的病理学特征有非干酪样肉芽肿、粘膜下层增宽、裂隙样溃疡和淋巴细胞聚集；肠结核的病理特征有肠壁或肠淋巴结干酪样坏死、粘膜下层变窄或闭缩。结论 尽管找到了克罗恩病和肠结核的临床、内镜和组织病理学特征，但手术标本的组织病理学在鉴别诊断中仍起决定作用。     

内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值

目的评价内镜及病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中的价值.方法回顾性分析161例溃疡性结肠炎和89例克罗恩病的临床资料,对其病变分布、内镜结果及病理检查进行了分析.结果克罗恩病好发于末段回肠、右半结肠及上消化道,而溃疡性结肠炎好发于直肠.克罗恩病的病理特征有非干酪样肉芽肿、裂隙样溃疡、淋巴细胞聚集、全层炎;溃疡性结肠炎的病理学特征有弥漫性或灶性黏膜炎症、隐窝脓肿、黏膜糜烂及溃疡.结论内镜结合病理检查在溃疡性结肠炎和克罗恩病鉴别诊断中起到决定性作用,尤其手术标本的病理检查对CD诊断价值较大.     

结核杆菌DNA检测在肠结核与克罗恩病鉴别诊断中的价值

目的：探讨聚合酶链反应（PCR）技术对肠结核和克罗恩病（Crohn's disease,CD)的鉴别诊断价值。并对其内镜活检组织的病理改变进行比较,方法：C地38例肠结核和30例CD活检组织进行病理分析、抗酸染色镜检和PCR技术检测结核杆菌DNA。结果：（1）淋巴细胞聚集在CD远较肠结核多见（P＜0．05）;而肉芽肿,尤其是干酪样肉芽肿和肉芽肿的融合在肠结核却更多见（P＜0．05）。两者其他病理特点的差异在活检组织中不明显或难以发现;（2）PCR技术检测结核杆菌DNA总阳性率为63．2％（24／38例）;在与CD肉芽肿形态相同的肠结核组中阳性率为71．4％（10／14例）;在无肉芽肿瘤变的肠结核组中阳性率为64．7（11／17例）。而该技术在CD组无1例阳性。抗酸染色镜检总阳性率为21．1％（8／38例）。结论：内镜活检病理对肠结核与CD的鉴别诊断有一定局限。PCR技术是鉴别肠结核和CD极有价值的一种新方法。     

早期肠结核的病理变化

目的探讨早期肠结核的病理变化。方法对结肠镜诊断的３例早期肠结核进行分析。结果早期肠结核的病理特征是：回盲部粘膜充血、水肿或（和）糜烂；纤维素样渗出及霜样白苔，回盲瓣红肿变形；无溃疡和息肉样增生；光镜下见粘膜层内结核结节，无溃疡和肉芽、纤维组织增生。结论认识早期肠结核的病理变化，对促进早期肠结核的诊断和完善肠结核的病理分型具有重要意义     

原发性肠淋巴瘤与克罗恩病的鉴别诊断

背景：原发性肠淋巴瘤的发病率较低，临床表现缺乏特异性，易误诊为其他胃肠道疾病，特别是与克罗恩病（CD）的鉴别诊断较困难。目的：通过分析原发性肠淋巴瘤和CD患者的临床资料，提高原发性肠淋巴瘤与CD的鉴别诊断水平。方法：回顾性分析原发性肠淋巴瘤和CD患者的临床特点、内镜表现和病理检查结果。结果：原发性肠淋巴瘤患者的平均年龄为50岁，CD为35岁。5例（12.2％）CD发生肛周病变，4例（9.8％）内瘘，3例（7.3％）有肠外表现，但仅1例（5.9％）原发性肠淋巴瘤曾有肛瘘。内镜下原发性肠淋巴瘤以回盲部受累多见（41.7％），CD以小肠和结肠均受累多见（48，8％）；原发性肠淋巴瘤以肿块型较多见（41.7％），CD则主要表现为溃疡和铺路石样改变，其中18例伴肠腔狭窄，4例瘘管形成。B细胞性原发性肠淋巴瘤13例，T细胞性4例。12例CD表现为非干酪样坏死性肉芽肿。结论：临床上原发性肠淋巴瘤与CD的鉴别诊断较困难，需综合各种检查手段，特别是内镜检查和内镜下对病变部位多点取活检，以提高诊断率。     

克罗恩病和肠结核的组织病理学研究

目的：明确克罗恩病和肠结核的组织病理学特征，找出异同点。方法：利用手术切除的肠结核和克罗恩病理标本，观察其组织病理学特征并比较。结果：克罗恩病的特征为裂隙性溃疡、非干酪样坏死性肉芽肿、肿膜下层增宽；肠结核的特征为干酪样坏死、粘膜下层闭锁，肉芽肿融合，组织切片有许多相似之处，如微肉芽肿，全层炎症等，结论：典型的肠结核和克罗恩病易于鉴别，但二者组织病理学的相似性，给部分病例的鉴别诊断带来困难。     

454例溃疡性结肠炎的临床及内镜检查分析

目的探讨结肠镜结合黏膜染色及活检组织病理学检查在溃疡性结肠炎（Ulcerative colitis，uc）诊断中的意义。方法 回顾分析我院5年来确诊的454例UC。结果本组454例UC中。发病以21～50岁为主（75．2％），临床表现以黏液血便或脓血便（60．6％）及腹痛（41．2％）为主。病变分布以直肠、直乙状结肠及左半结肠最多见（63．7％）。结肠镜下表现以黏膜充血水肿（93．6％）伴糜烂（91．4％）或浅溃疡（62．6％）最常见。结论结肠镜检查结合黏膜染色及活检组织病理学检查对UC的诊断具有重要价值。     

胃肠道结核的内镜与病理

目的总结胃肠道结核的内镜诊断经验，以引起对这个特殊疾病的重视，减少漏诊和误诊。方法内镜检查发现胃肠道黏膜隆起、结节、红斑、溃疡等病变，行黏膜活检病理。结果7例患者中，胃结核2例，其中溃疡型1例，增殖型1例；肠结核5例，其中增殖型4例，混合型1例。病变部位：胃窦部2例，回肠末端1例，回盲瓣1例，回肠末端和回盲瓣1例，回肠末端及结肠多处病变1例，升结肠1例。内镜诊断：1例结合有浸润型肺结核诊断为肠结核，2例诊断为结肠恶性肿瘤，4例诊断为胃肠黏膜隆起或溃疡性病变性质待定。7例患者活检组织病理均为干酪样坏死肉芽肿，符合结核。结论胃肠道结核病内镜下表现多种多样，与结肠癌、克罗恩病等炎性肠病及胃良恶性溃疡难以鉴别，需依赖黏膜活检病理诊断。     

如何通过黏膜活检和超声内镜提供IBD的诊断线索

炎症性肠病(IBD)包括克罗恩病和溃疡性结肠炎,与肠道结核、淋巴瘤等均以肠道溃疡为特征,诊断往往依赖病理诊断金标准。但在临床上由于病理活检取材的局限,常不能提供疾病确诊的病理学依据,因而相互间的鉴别诊断较困难,常为临床上的治疗带来困惑。本文根据作者长期的内镜活检和超声内镜检查经验,介绍如何通过黏膜活检和超声内镜提供IBD的诊断线索,为临床医生确诊该类疾病提供借鉴和帮助。     

67例小肠克罗恩病的临床分析

背景：克罗恩病（CD）好发于末端回肠和回盲部,临床表现多种多样,但检查手段有限。目的：探讨小肠CD的临床特点和诊治情况。方法：回顾性分析2000年1月～2007年12月南京鼓楼医院收治的小肠CD患者的临床资料。结果：共纳入67例小肠CD患者,男女之比为4．15：1,诊断年龄13—79岁．其中20—29岁和50—59岁为两个发病高峰。临床症状主要表现为黑便或血便或脓血便43例（64．2％）、腹痛36例（53．7％）、贫血27例（40．3％）、腹泻26例（38．8％）。最常见的并发症为肠梗阻,穿孔少见。结肠镜下可见节段性病变、黏膜充血水肿、铺路石样改变等：胶囊内镜下表现为多发不规则溃疡、线样溃疡、阿弗他溃疡;手术病理活检示全壁性炎症、深裂隙状纵行溃疡、结节样肉芽肿。病变多位于末端回肠和（或）回盲部（49.3％）。接受胶囊内镜和结肠镜检查者经内科治疗后症状得到控制。14例患者因消化道出血、肠梗阻、穿孔而行手术治疗。结论：小肠CD的诊断较困难,可首选结肠镜检查。若无完全性肠梗阻可行胶囊内镜检查。与结肠镜和小肠造影检查相比．胶囊内镜对于早期小肠CD的诊断和患者病情的评估有一定优势,可推迟部分患者的第一次手术时间。     

缺血性结肠炎与溃疡性结肠炎的临床鉴别诊断

背景:缺血性结肠炎(IC)与溃疡性结肠炎(UC,左半结肠型)在临床和内镜表现上有一定相似之处,对于临床表现不典型者,初步诊断颇具难度。目的:分析IC与UC的临i床鉴别诊断要点。方法:收集武汉大学中南医院2008年1月～2009年12月确诊为IC或UC左半结肠炎的住院患者,对其病史资料进行回顾性分析。结果:21例IC和25例UC患者纳入研究。IC患者以老年女性居多,病程相对较短,常伴有高血压和糖尿病,最突出的临床表现为突发腹痛后24 h内出现便血,贫血少见;UC患者的主要临床表现为黏液血便伴腹痛,贫血常见。IC病变多仅累及单一肠段,直肠受累少见,溃疡小而表浅,病理学表现为慢性炎,隐窝炎罕见;UC病变多起源于直肠,呈连续性,溃疡弥漫,病理学表现为慢性炎伴多种炎性细胞浸润,隐窝炎、隐窝脓肿常见。结论:根据性别、年龄、病程以及临床、实验室、内镜和病理检查结果进行综合分析,有助于IC与U C的鉴别诊断。     

Endoscopic diagnosis of lower intestinal lesions of leukaemia and malignant lymphoma

There have been only a few endoscopic studies with respect to lower intestinal lesions of leukaemia and malignant lymphoma, although there have been many autopsy studies of these lesions. The aim of this study was to clarify these lesions using endoscopy. Colonoscopy was performed on 11 of 341 patients with leukaemia and on 32 of 105 patients with malignant lymphoma for frequent diarrhoea, anal bleeding or abnormal findings on barium enema examination, between April 1984 and September 1994. In eight of the 11 patients with leukaemia on whom endoscopy was performed, nine lesions were found; aphthoid ulcers, small ulcers or large tumours due to leukaemic infiltration were found in five, and colorectal adenoma was found in only one patient. Antibiotic-associated haemorrhagic colitis or pseudomembranous colitis was found in one patient each. In 10 of the 32 patients with malignant lymphoma, 11 lesions were found. The following were found in one patient each: large lymphomatous tumours, a large lymphomatous ulcer, multiple small polypoid lesions, multiple lymphomatous polyposis; and colorectal cancer or adenoma in six patients. However, the autopsy findings in patients with both diseases were mostly pseudomembrane formation or ulcers due to fungal and/or bacterial infection. It is concluded that accurate endoscopic diagnosis of lower intestinal lesions in patients with leukaemia or malignant lymphoma is essential for staging and treatment of these diseases and for determining their prognosis. Most lesions in leukaemia are aphthoid and small ulcers are due to leukaemic infiltration or antibiotics; most lesions in malignant lymphoma are elevated lesions such as cancer, adenoma or lymphomatous lesions as determined by endoscopy. This is in contrast to pseudomembrane formation or ulcers due to fungal and/or bacterial infection which are detected at autopsy.     

Intestinal Tuberculosis: Clinicopathologic Analysis and Diagnosis by Endoscopic Biopsy

Objective: Tuberculosis is still an important cause of granulomatous colitis in developing countries. If we can diagnose tuberculosis using endoscopic biopsy material, clinicians can avoid invasive diagnostic procedures and needless operations. For this purpose, we evaluated clinical manifestations, pathological findings, and diagnostic methods in endoscopically biopsied intestinal tuberculosis patients.
Methods: From January 1991 to December 1996, 42 patients with intestinal tuberculosis were endoscopically examined and tissue culture, immunohistochemical stain, Ziehl-Neelsen stain, and polymerase chain reaction in fresh and fixed tissue were applied. The pathological findings were analyzed and compared with the results of the other diagnostic methods.
Results: In tuberculosis patients, transverse ulcers with surrounding hypertrophic mucosa and multiple erosions were usual colonoscopic findings. The granulomas were found in 74% of the cases. The positivity ranged from 30–45%. There were no significant differences in the positivity among those diagnostic methods (   p > 0.05  ). The positivity of Ziehl-Neelsen stain in fixed tissue was higher in the group having granulomas and it was reversed in PCR (   p < 0.05  ). The increasing number of biopsy particles raised the positivity of Ziehl-Neelsen stain and PCR in fixed tissue (   p < 0.05  ). Conclusions: Transverse ulcers were the most characteristic colonoscopic finding and granulomas were frequent pathological findings in intestinal tuberculosis. Higher positivity and reliable results were found in tissue culture, Ziehl-Neelsen stain, and polymerase chain reaction. To increase the diagnostic rate, the endoscopist should take enough tissue and deep biopsy material from ulcer bases and diseased mucosae.     

克罗恩病与肠结核临床、内镜及病理特征对比分析

目的对比分析克罗恩病与肠结核的临床、内镜及病理特征。方法选取南方医科大学珠江医院2006年3月-2012年3月住院并确诊为克罗恩病、肠结核的患者资料,进行回顾性分析,其中克罗恩病组(CD组)39例,肠结核组(ITB组)34例。结果 CD组血便多于ITB组,而ITB组盗汗、腹水多于CD组(P均0.05);CD组合并瘘管形成较多,ITB组则多合并肠外结核,两组比较差异有统计学意义(P均0.05);ITB组PPD试验阳性率明显高于CD组(P0.05);CD组纵形溃疡、鹅卵石征、节段性改变、假性息肉、黏膜桥多见,而ITB组环形溃疡、回盲瓣受累明显(P均0.05);裂隙状溃疡仅见于CD,干酪样肉芽肿仅见于ITB。结论临床上应综合分析二者的临床特征,结合内镜及病理对其鉴别诊断进行综合分析,才能进一步提高诊断的准确率。     

Primary colorectal lymphoma comprising both components of diffuse large B-cell lymphoma and mucosa-associated lymphoid tissue lymphoma combined with cytomegalovirus colitis

A 16-year-old girl presented to our hospital with diarrhea and abdominal pain. The macroscopic findings of colonoscopy revealed multiple submucosal tumors and multiple ulcers, which were localized in the sigmoid colon, and diffuse granular mucosa which extended to the total colon. The pathological diagnosis was malignant lymphoma comprising both components of diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma, because the large lymphoma cells were CD20+, CD10?, and CD5?. Furthermore, immunohistochemical analysis of colorectal biopsy samples from multiple ulcers revealed cytomegalovirus (CMV)-positive cells. The patient was diagnosed with primary colorectal lymphoma comprising both components of DLBCL and MALT lymphoma combined with CMV colitis. She received anti-viral medication and chemotherapy.     

Detection of anti-cord factor antibodies in intestinal tuberculosis for its differential diagnosis from Crohn's disease and ulcerative colitis

We have developed a diagnostic method for pulmonary tuberculosis by detecting antibody to cord factor using enzyme-linked immunosorbent assay (ELISA). This study was to evaluate the usefulness of our method for a diagnosis of intestinal tuberculosis, and especially its ability to differentiate this disease from other inflammatory bowel diseases. Antibodies of the immunoglobulin G class against cord factor (trehalose-6,6'-dimycolate) from 27 patients with intestinal tuberculosis, 16 patients with Crohn's disease (CD), and 27 patients with ulcerative colitis (UC) were tested by ELISA with cord factor purified fromMycobacterium tuberculosis H37Rv as the antigen. Twenty-three of the 27 patients with intestinal tuberculosis (85%) showed elevated values distinct from healthy controls. None of the patients with CD showed an elevation of antibody titers. Of the 27 patients with UC, 26 (96%) did not show any anti-cord factor antibody elevation. We conclude that this method is simple and results are reproducible. The results of our study justify undertaking the detection of anti-cord factor antibodies to diagnose intestinal tuberculosis.     

溃疡性结肠炎及克罗恩病的内镜活检病理特点分析

目的 总结溃疡性结肠炎（UC）及克罗恩病（CD）的病理形态学特点,为其诊断提供借鉴.方法 收集临床首次诊断并经病理科证实的UC患者180例、CD患者106例,资料包括年龄、性别及病变累及肠道的部位,并选用病理组织学标准对病变的黏膜结构改变、黏膜慢性炎症细胞浸润、黏膜急性炎症改变、黏膜上皮改变进行评价,比较两类患者间的差异.结果 和CD病例比较,UC病例出现黏膜结构紊乱的比例较高（P＜0.05）,出现局灶间断性炎症的比例较低（P＜0.05）,隐窝炎、隐窝脓肿及固有膜内中性粒细胞浸润发生率较高（P＜0.05）,表面上皮变扁或糜烂、黏液细胞减少的发生率较高.肉芽肿样小结、假幽门腺化生及裂隙状溃疡改变仅出现在CD病例.180例UC病例中90%（162例）病例病变部位局限于结肠.106例CD病例中28%（30例）病变部位局限于回盲部,56%（59例）病变累及到2个及以上不同部位.结论 肠镜活检病理诊断UC及CD是一个综合分析的过程.若病变局限于回盲部或胃肠道多部位累及,黏膜出现肉芽肿样小结、局灶间断性炎细胞浸润、假幽门腺化生等改变则倾向于CD诊断;若病变局限于结肠,黏膜出现弥漫一致性炎或明显的黏膜结构改变、黏膜上皮改变则倾向于UC诊断.