阑尾残端置管给药治疗难治性溃疡性结肠炎的临床探讨(附16例报告)

目的探讨难治性重型溃疡性结肠炎的有效治疗方法。方法回顾性分析我院1997年1月～2006年12月采用经阑尾残端置管给药治疗难治性重型溃疡性结肠炎16例的临床资料。结果完全缓解10例,有效6例。结论经阑尾残端置管给药行规范化的内科治疗具有副作用小、操作简单、使用方便、疗效好的优点,对难治性及重症溃疡性结肠炎不失为一种有效的治疗方法。     

Potential Utility of Fecal Calprotectin in Discriminating Colorectal Polyps From Other Major Etiologies in Children Presenting With Isolated Hematochezia

BackgroundColorectal polyps are the most common cause of isolated hematochezia in children, which requires a colonoscopy for diagnosis. We aimed to investigate the potential utility of fecal calprotectin (FC) in assessing colorectal polyps detected by colonoscopy among children presenting with isolated hematochezia.MethodsPediatric patients of the age of < 18 years who had undergone both colonoscopy and FC tests for isolated hematochezia from June 2016 to May 2020 were included in the present multicenter, retrospective, cross-sectional study. Comparative analysis was conducted between major causes of isolated hematochezia and FC cut-offs for discriminating colorectal polyps were explored.ResultsA total 127 patients were included. Thirty-five patients (27.6%) had colorectal polyps, followed by anal fissure (14.2%), ulcerative colitis (UC; 12.6%), and others. A significant difference in FC levels was observed between patients with colorectal polyps (median, 278.7 mg/kg), anal fissures (median, 42.2 mg/kg), and UC (median, 981 mg/kg) (P < 0.001). According to receiver operating characteristic curve analysis, among patients diagnosed with colorectal polyp or anal fissure, the most accurate FC cut-off for discriminating colorectal polyps from anal fissures on colonoscopy was 225 mg/kg (sensitivity, 59.4%; specificity, 94.4%; positive predictive value [PPV], 95.0%; negative predictive value [NPV], 56.7%; area under the curve [AUC], 0.8; 95% confidence interval [CI], 0.678–0.923; P < 0.001), while among patients diagnosed with colorectal polyp or UC, the most accurate FC cut-off for discriminating colorectal polyps from UC on colonoscopy was 879 mg/kg (sensitivity, 81.2%; specificity, 56.2%; PPV, 78.8%; NPV, 60.0%; AUC, 0.687; 95% CI, 0.521–0.852; P < 0.001).ConclusionFC may assist in assessing the cause of lower gastrointestinal tract bleeding in children who present with isolated hematochezia.     

深在性囊性结肠炎并发肠梗阻1例报告和文献复习

报告１例少见病：深在性囊性结肠炎,患者因反复腹痛,腹泻低热,贫血,消瘦２年余入院,因并发不完全性小肠梗阻,持续１个月不缓解,而行剖腹探查。行右半结肠和部分小肠切除术,明确诊断,术后病情缓解。本病的组织病理特征为多发性囊肿性病变位于肠壁的粘膜下层,囊肿壁内衬以细胞无异常的单层柱状,立方或扁平上皮,病变周围有慢性炎细胞浸润。结合文献复习,对本病的病因、临床特点、诊断、鉴别诊断和治疗进行了讨论。     

消溃散对溃疡性结肠炎（湿热内蕴型）患者血清IL-8 、IL-10的影响观察

目的：观察消溃散对溃疡性结肠炎（UC）患者临床疗效及血清IL-8、IL-10的影响.方法：UC患者60例随机分为观察组和对照组各30例,并设健康对照组.观察组以消渍散治疗;对照组以柳氮磺胺吡啶治疗,疗程均为2个疗程,观察消溃散疗效及其对患者IL-8、IL-10的影响.结果：观察组在改善腹泻、腹痛、粘液脓血便以及结肠镜下粘膜修复方面优于对照组（P＜0.05）.并且可降低血清IL-8、血清IL-10的水平接近健康组,高于对照组（P＜0.05）.结论：消溃散可能通过降低血清IL-8水平和IL-10的水平,从而改善溃疡性结肠炎患者的排便症状.     

腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病及溃疡性结肠炎中的临床应用

目的:探讨腹腔镜全结肠切除术在家族性腺瘤性结肠息肉病(familial adenomatous polyposis,FAP)及溃疡性结肠炎(ulcerative colitis,UC)治疗中的应用价值。方法:回顾分析2009～2012年为12例患者行腹腔镜全结肠切除术(FAP患者7例,UC患者5例)及18例传统开腹全结(直)肠切除术(FAP患者7例,UC患者11例)的临床资料。结果:腹腔镜组在切口长度、术中出血量、术后止痛药使用量、术后排气时间、拔除导尿管时间、术后住院时间等方面优于开腹组,住院总花费明显高于传统开腹手术。结论:腹腔镜全结肠切除术用于FAP及UC安全、可行,与传统开腹手术相比,具有患者创伤小、康复快等优点,手术效果不亚于传统开腹手术,具有较高的临床应用价值。     

Sonographic diagnosis of colitis in children

To assist the radiologist in differentiating the colitis in children, this review proposes a systematic US approach to the disease, presents the US aspect of the normal colon and describes three distinctive US patterns reflecting the intramural extension of the histopathological changes. Each pattern corresponds to one or several diseases producing alterations in the same layer(s). Stratified thickening suggests an inflammatory mucosal process resulting from infection (as in advanced appendicitis or in infectious colitis) or to inflammation (as in IBD). Nonstratified thickening with loss of the haustral folds reflects a marked submucosal infiltrate. Color Doppler is required to distinguish between an inflammatory disease (as advanced CD or neutropenic colitis) and an ischemic colitis (HUS in children). Nonstratified thickening with preservation of the length of the haustral folds is the sign of an intraluminal deposit due to PMC. Correlating the sonographic pattern and the anatomic distribution of the disease with the clinical and laboratory findings often permits to propose a specific diagnosis.     

全大肠切除回肠贮袋肛管吻合术的远期疗效评价

目的　探讨全大肠切除回肠贮袋肛管吻合术治疗溃疡性结肠炎 (UC)和家族性腺瘤性息肉病 (FAP)的远期疗效。方法　 1985～ 2 0 0 2年间共对 6 1例患者行全结肠直肠切除回肠贮袋肛管吻合术 ,其中UC 2 5例、FAP 34例、其他 2例 ,应用S袋 2 5例、S J袋 13例、J袋 17例以及W袋 6例 ,术后随诊 1～ 18年、平均 8年 ,比较分析术后控便功能及并发症。结果　全部患者存活。并发症发生率为 16 % ( 10 / 6 1) ,其中UC患者 ( 2 4 % ,6 / 2 5 )高于FAP患者 ( 12 % ,4 / 34) ,W袋高于其他各袋 ,手法吻合 ( 2 0 % ,8/ 4 1)高于吻合器吻合 ( 10 % ,2 / 2 0 ) ,但差异均无显著性 (P >0 0 5 )。术后 2 4h大便次数平均为 4 2次。日间 84 % ( 4 3/ 5 1)、夜间 75 % ( 38/ 5 1)的患者排便能自控 ,6 % ( 3/ 5 1)的患者有明显的大便失禁。大部分患者对目前的生活质量表示满意。结论　全大肠切除回肠贮袋肛管吻合术治疗可维持UC与FAP患者肛管自控功能和可接受的大便次数 ,术后并发症较少 ,是较为理想的手术方式     

参苓白术散对脾虚湿困型溃疡性结肠炎大鼠结肠组织ERK、p38 MAPK蛋白表达的影响

目的：探讨脾虚湿困型溃疡性结肠炎（Ulcerative Colitis,UC）大鼠结肠组织中ERK、p38MAPK蛋白表达的变化及参苓白术散的干预作用。方法40只Wistar大鼠随机分为正常对照组、模型对照组、柳氮磺吡啶组、参苓白术散组,每组10只。采用环境与饮食干预结合TNBS/乙醇灌肠法复制脾虚湿困型UC大鼠模型,应用免疫组织化学法检测各组大鼠结肠组织中ERK、p38MAPK蛋白表达情况。结果模型对照组大鼠结肠组织ERK、p38MAPK表达明显增多,与正常对照组比较具有显著性差异（P〈0.05）。柳氮磺嘧啶组和参苓白术散组大鼠结肠组织ERK、p38MAPK的表达与模型对照组比较差异有统计学意义（P〈0.05）。参苓白术散组大鼠结肠组织ERK、p38MAPK的表达与柳氮磺嘧啶组比较差异亦有统计学意义（P〈0.05或P〈0.01）。结论脾虚湿困型UC大鼠结肠组织ERK、p38MAPK表达明显增强,参苓白术散治疗可显著降低其ERK、p38MAPK的表达水平。     

感染后肠易激综合征与溃疡性结肠炎缓解期病人直肠黏膜细胞因子的表达

目的探讨感染后肠易激综合征（PI-IBS）与溃疡性结肠炎（ UC）缓解期病人肠黏膜细胞因子的表达,从神经-免疫机制分析肠易激综合征（IBS）与炎症性肠病（IBD）的相关性。方法 PI-IBS组病人20例,UC组病人45例,正常对照组30例,结肠镜下取直肠黏膜标本,采用免疫组化方法检测其肠黏膜细胞因子的表达情况。结果PI-IBS病人直肠IFN-γ、IL-2阳性表达高于对照组（χ^2=14.012、13.931,P〈0 .01） ,而与UC病人比较差异无统计学意义（χ^2=2.290、2.323,P〉0 .05）。PI-IBS病人直肠黏膜P物质（SP）强度均值高于对照组（t=3.722,P〈0 .01） ,而与UC病人比较差异无统计学意义（t=1.643,P〉0 .05）。直肠黏膜IFN-γ、IL-2阳性表达的PI-IBS病人SP强度均值高于对照组（t=2.301、2.252,P〈0 .05） ,与UC病人比较差异无统计学意义（t=1.574,1.676,P〉0 .05）。结论 PI-IBS与IBD之间可能存在某种相关性。     

活动期溃疡性结肠炎发病机制的免疫学探讨

目的 :目前研究认为溃疡性结肠炎发病机制与免疫因素有关 ,已有研究表明溃疡性结肠炎与白细胞介素6 (IL - 6 )、白细胞介素 8(IL - 8)密切相关。另有报导认为一氧化氮合酶 (NOS)与溃疡性结肠炎有关 ,但是IL- 6、IL - 8与NOS关系的报导并不多见。为了揭示活动期溃疡性结肠炎结肠粘膜细胞因子 (白细胞介素 6、白细胞介素 8)的表达 ,以及与诱导型一氧化氮合酶 (iNOS)的关系 ,进一步探讨溃疡性结肠炎免疫学发病机制 ,设计本研究。方法 :对 34例活动期溃疡性结肠炎粘膜标本及 10例正常结肠粘膜标本进行iNOS的免疫组织化学分析及IL - 6mRNA ,IL - 8mRNA的原位杂交技术检测分析。结果 :34例活动期溃疡性结肠炎粘膜标本IL - 6mRNA有 2 8例阳性 (83% ) ,较对照组明显增高 (P <0 .0 1) ,IL - 8mRNA有 2 7例阳性 (79% ) ,与对照组相比明显增高 (P <0 .0 1) ,iNOS阳性 30例 (88% ) ,与对照组比较增高 (P <0 .0 5 )。结论 :细胞因子 (IL- 6 ,IL - 8)及诱导型一氧化氮合酶 (iNOS)在活动期溃疡性结肠炎免疫学发病机制中起重要作用 ,细胞因子是iNOS活性增加的重要原因。