炎症性肠病152例临床病理分析

为探讨炎症性肠病（IBD）的临床病理特点和治疗方法，回顾性分析152例IBD患者的临床资料，肠镜、病理检查及治疗方法。结果显示，临床主要表现：93例溃疡性结肠炎（UC）以腹泻为主，伴有腹痛和黏液脓血便，腹痛多位于左下腹和左腰腹部；59例克罗恩病（CD）以腹痛为主，伴有腹泻和黏液或水样便，腹痛多位于右下腹和脐周。病变范围：UC以直肠和全结肠为主；CD以末端回肠及其邻近结肠为主。临床类型：UC以初发型及慢性复发型多见；CD以狭窄型为主。内镜及病理大体检查：UC为多发性表浅溃疡、连续性弥漫性黏膜充血糜烂，病理检查镜下隐窝脓肿较多见；CD为节段性、非对称性的黏膜炎症，病理检查镜下黏膜下层见结节样肉芽肿。CD并发症较多，主要为肠梗阻、瘘管及肠穿孔。UC结肠镜病理活检确诊率为96．8％，3．2％的病例是经手术标本病理活检确诊。CD结肠镜病理活检确诊率为59．3％，40．7％的病例是经手术标本病理活检而确诊。结果表明，IBD临床表现多样，CD并发症较UC多见，误诊率较高，结肠镜病理活检是诊断UC和CD的有效方法。合理内科治疗和选择性外科治疗可提高IBD的治疗效果。

Clinical Pathologic Analysis on Inflammatory Bowel Disease of 152 Cases

For the objective of investigating the clinical pathologic features and treatment method ot inflammatory bowel disease（IBD） author analysed the clinical data, as well enteroscopy, pathology examination and treatment methods of 152 patients with IBD retrospective. As results,in main clinical manifestations, 93 patients with ulcerative colitis（UC） presented mainly diarrhea,associated with abdominal pain and mucous pus blood stool, which the former symptom occured mostly at left-down abdomen and left lumbar-abdomen; 59 patients with Crohn＇s disease（CD）,mainly abdominal pain,associated with diarrhea and mucous or watery stool, which the abdominal pain mostly at right-down abdomen and peri-umbilicus; in lesion range,the range of UC mainly presented at rectum and whole colon,while the range of CD at end ileum and its closed colon;in clinical pattern, UC mostly presented primary-onset type and chronic reccurence type, while CD,stricture type; in endoscopy and gross specimen pathologic examination, UC presented multiple superficial ulcer, continous diffuse mucous membrane congestion erosion, under microscope seen mostly crypt abscess,while CD presented segmental asymmetrical mucous membrane inflammation, under micro- scope seen nodular granuloma in the inferior-layer of mucous membrane;in UC the confirmed diagnostic rate by coloscopy pathologic biopsy was 96.8% ,and rest 3.2 % were confirmed by pathologic examination of operative specimen, while in CD was 59.3 % and 40.7% ;otherwise, the complications of CD were more, mainly intestinal obstruction, fistula and perforation. Above results show that IBD presents variously in clinical manifestations, the complication of CD is more common than that of UC,and its misdiagnostic rate is higher;Coloscopy pathologic biopsy is an effective method for diagnosing UC and CD;and rational medication and selective surgical therapy can enhance the therapeutic effect of IBD.