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。

Endoscopic and pathologic of gastrointestinal tuberculosis

Objective To report the experience in diagnosing gastroenteric tuberculosis under en-doscopies, and arose enough attention to avoid missed or mis-diagnosis. Methods Biopsy is taken when lesions, such as gastroenteric mucosal protrusions, nodule, erythema and ulcer are found under endoscopies. Results In 7 cases studied, 2 of them are the gastric tuberculosis (1 ulceration, 1 proliferation) , the rest, colonic tuberculosis (4 proliferation and 1 mixed). Distribution of lesions: gastric antrum 2, each one in terminal ileum, ileocecal valve, terminal ileum plus ileocecum, terminal ileum plus pan colon, and ascending colon. Endoscopic diagnosis: colonic tuberculosis with infiltrative tuberculosis in both lungs 1; colonic malignant tumors 2, mucosal protrusions and ulcerative lesions with undefined nature 4. Caseous necrotic granu-lomas are found in all cases on pathological examination. Conclusion The various appearances of gastroenteral tuberculosis under endoscopies are hard in differentiating from those of colonic carcer, inflammatory bowel diseases ( Crohn' s disease etc. ) , gastric benign or malignant ulceration. The definite diagnosis of gastroenteral tuberculosis is greatly depended on pathological results.