内镜及活检病理对回盲部溃疡的鉴别诊断

目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡，结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌（溃疡型）进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断；对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明：异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义（P〈0．05）；单纯类上皮结节（即结节样肉芽肿）见于克罗恩病和肠结核病，若未发现肠结核干酪样坏死，两者不易鉴别；隐窝脓肿多见于溃疡性结肠炎，但该病理特征诊断意义不强，可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的，综合分析其结果可进一步提高诊断准确率。

The differential diagnosis of ileocecal ulcerative disease under colonoscopy and biopsy

Objective To be detected the causes of ilecocecal ulcerative disease by colonoscopic and pathological examination. Methods The inpatients records of endoscopy and biopsy were reviewed and then based on these findings to differentiate and confirm the main diseases such as intestinal tuberculosis, Crohn's disease, ulcerative colitis, colorectal malignant lymphoma and cancer of colon. Results It is shown from endoscopy the diagnosis of ulcerative colitis and carcinoma of colon can be readily set down, but with relatively low diagnostic efficiency in intestinal tuberculosis, Crohn's disease and malignant lymphoma. The pathologic results of endoscopic biopsy specimen revealed that dysplastic epithelium/epithelioid and caseous necrosis have relatively diagnostic significance in malignant lymphoma, ulcerative carcinoma of colon and intestinal tuberculosis ( P < 0. 05 ) . But it is sometimes hard to distinguish Crohn's disease from intestinal tuberculosis if only found epithelioid nodules (nodular grannuloma) without caseous necrosis. Crypt fosse with abscess are commonly found in ulcerative colitis but it is not specific can be found in a lot of diseases, and cannot be served as an evidence of diagnosis criteria. Conclusion The ulcerative disease mostly found in il-eocecal region, could be reliable and safely diagnosed by colonoscopy and biopsy, furthermore, combination of these two procedures could further improve the efficacy in diagnosis.