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。

Clinical Analysis of 67 Patients with Small Intestinal Crohn's Disease

Background： Crohn＇s disease （CD） occurs in terminal ileum and ileocecal region with various clinical manifestations, and has only limited detection methods. Aims： To investigate the clinical characteristics, diagnosis and treatment of small intestinal CD. Methods： The clinical data of patients with small intestinal CD admitted from January 2000 to December 2007 at Nanjing DrumTower Hospital were retrospectively reviewed. Results： Sixty-seven patients with small intestinal CD were enrolled in this study. The ratio of male to female was 4.15：1. The age at diagnosis of CD patients ranged from 13 to 79 years, of which 20-29 year and 50-59 year were the two peaks. The predominant clinical manifestations included melena or bloody stool or bloody purulent stool （43 cases, 64.2%）, abdominal pain （36 cases, 53.7%）, anemia （27 cases, 40.3%） and diarrhea （26 cases, 38.8%）. The most commonly seen complication was bowel obstruction, but perforation was rare. Colonoscopic findings showed segmental lesion, mucosal hyperemia, edema and cobblestone-like appearance. The most frequent findings by capsule endoscopy were multiple irregular ulcers, linear ulcers and aphthae ulcers, Surgical biopsy showed inflammation of the whole wall, slit-like longitudinal ulcers and nodular granuloma. The lesions mostly occurred in terminal ileum and/or ileocecal region （49.3%）. The symptoms of patients undergone capsule endoscopy and colonoscopy were under control with medical treatment. Fourteen patients accepted surgery due to gastrointestinal hemorrhage, bowel obstruction and perforation. Conclusions： The diagnosis of small intestinal CD is difficult. Colonoscopy can be the first option. Capsule endoscopy should be performed in patients without complete intestinal obstruction. Compared with colonoscopy and small intestinal contrast imaging, capsule endoscopy is superior in the early diagnosis and assessment of disease status of small intestinal CD, and can postpone the first operation time in some patients.