放大肠镜在重症急性胰腺炎早期的结肠黏膜损害中的诊断价值

目的:探索放大肠镜在重症急性胰腺炎(SAP)早期肠黏膜屏障功能障碍导致的结肠黏膜损伤诊断中的价值。方法:对35例早期SAP病人进行放大肠镜检查,观察结肠黏膜有无损害,并取活检进行病理学光镜和电镜检查,同时对其进行APACHEⅡ评分、胃肠功能评分、胰周组织感染发生率统计。结果:71.4%(25/35)的早期SAP病人在放大肠镜检查中发现有结肠黏膜损伤,包括黏膜水肿、出血、糜烂。77.1%(27/35)的病人活检组织病理检查发现异常,包括黏膜上皮脱落、紧密连接缩短、细胞间分离。放大肠镜发现结肠黏膜损伤的病人其病理检查异常率、APACHEⅡ评分、胃肠功能评分、胰周感染发生率均高于未发现结肠黏膜损伤的病人。结论:对早期SAP病人进行放大肠镜检查,能够评估病人疾病的严重程度,预测病程进展中发生胰周感染的概率。

Role of magnifying colonoscopy in diagnosing colonic mucosa injury at the early stage of severe acute panreatitis

Objective To evaluate the role of magnifying colonoscopy in the diagnosis of colonic mocosa injury caused by gut barrier dysfunction during the early stage of severe acute pancreatitis （SAP）. Methods Thirty-five early stage of SAP patients underwent magnifying colonoscopy, biopsy were performed to examine the pathological changes of the mueosa. APACHE Ⅱ scores, gastrointestinal function scores and the rate of peri-pancreatic infection were analyzed simuhaneouly. Results Of the 35 patient, 25 or 71.4% were found to have colonic mucosa lesions by magnifying colonoscopy, including mucosal edema, hemorrhage and anabrois. Twenty-seven or 77.1% （27/35） of the biopsy specimens demonstrated pathological changes, including the shedding of epithelium mucosa , decurtation of tight junction and cell detachment. The rate of abnormal pathological changes, PACHE Ⅱscores, gastrointestinal function scores, as well as the rate of peri-pancreatic infection in patients with abnormal colonoscopic findings were higher than those without colonoscopic abnormalities. Conclusions Magnifying colonoscopy at the early stage of SAP might help to evaluate the severity of this disease, and predict the risk of peri-pancreatic injury.