回盲部溃疡228例的回顾性分析

目的探讨内镜及病理检查对回盲部溃疡的鉴别诊断价值.方法 收集我院2006年至2010年肠镜检查中检出的228例回盲部溃疡病例,就其临床特征、内镜及病理检查、治疗及随访情况进行总结分析,并比较克罗恩病及肠结核内镜下的形态特征.结果 (1)溃疡性结肠炎及回盲部肿瘤结合内镜及活检组织病理检查通常可明确诊断,回盲部的非特异性溃疡局部溃疡整齐或局限,多数经抗生素及培菲康等对症治疗后症状缓解,克罗恩病及肠结核只有少数通过内镜及病理活检确诊,多数经试验性治疗后随访明确诊断.(2)克罗恩病的溃疡多呈纵形或不规则形伴黏膜卵石征和肠腔狭窄,而肠结核溃疡多呈环形或环周分布伴息肉样变.结论 回盲部溃疡病变诊断主要依靠反复的病理检查及试验性治疗,尤其是肠结核和克罗恩病的诊断,因此寻找一种特异性血清或免疫组化的指标鉴别诊断回盲部溃疡是非常必要的.

Retrospective analysis 228 patients of ileocecal ulcer

Objective To disscuss the differential diagnosis value of endoscopic and pathological examination to 228 patients of ileocecal ulcer.Methods Retrospective analysis of the clinical datas of the 228 patients with ileocecal ulcer,and compared the endoscopic morphology of Crohn′s disease and intestinal tuberculosis.Results(1)The patients with ulcerative colitis or ileocecal tumor were usually diagnosed by colonoscopy and histopathology,The patients with nonspecific ileocecal ulcer relived after treatment,and their ileocecal ulcers were neat or limited;Most of the patients with Crohn′s disease or intestinal tuberculosis were followed up after test treatment and diagnosed,when a few of them were diagnosed by colonoscopy and histopathology.(2)Longitudinal or irregular ulcers,cobblestone appearance and strictures were more common in patients with Crohn′s disease,when transverse ulcers and pseudopolyps were more frequently observed in patients with intestinal tuberculosis.Conclusion The diagnosis of ileocecal ulcer lesions rely mainly on histopathology and test treatment,especially intestinal tuberculosis and Crohn′s disease;it is necessary to find a specific serum or immunohistochemical indicator to differential diagnosis of ileocecal ulcer.