结肠镜结合病理检查对结直肠溃疡病因诊断的价值

结直肠溃疡可由多种疾病所致，目前结肠镜结合病理检查是诊断结直肠溃疡病因的主要手段。目的：探讨不同病因结直肠溃疡的特征和诊断方法，以期提高对相应疾病的认识。方法：回顾性分析四川大学华西医院93例结直肠溃疡患者的临床特点、结肠镜检查和活检病理资料。结果：结直肠溃疡的病因以溃疡性结肠炎（UC）、肠结核、缺血性结肠炎、结直肠孤立性溃疡、克罗恩病（CD）、感染性肠炎、内痔，息肉术后、恶性淋巴瘤等常见。临床诊断的敏感性为33．3％，病理诊断为46．2％，内镜诊断为61．3％，结肠镜检查结合病理诊断为73．1％。结肠镜下UC多为弥漫分布的不规则浅小溃疡；肠结核多为环形溃疡；CD多有铺路石样改变；缺血性结肠炎病变与正常肠段界限明显。多数UC患者可见隐窝脓肿；异型淋巴细胞见于恶性淋巴瘤，经免疫酶标检查可证实；干酪样肉芽肿和抗酸染色阳性对肠结核有确诊意义，肠结核和CD中均可见非干酪样肉芽肿。结论：结直肠溃疡病因复杂多样。结肠镜结合病理检查对结直肠溃疡的病因诊断具有重要价值。可显著提高其诊断敏感性。

Role of Colonoscopy plus Biopsy in the Diagnosis of Colorectal Ulcerative Diseases

Many kinds of diseases can cause eolorectal ulcers, eolonoscopy plus biopsy is still the major diagnostic method. Aims： To appraise the characteristics and diagnostic methods of colorectal ulcers caused by various diseases for improving the recognization of corresponding diseases. Methods： Clinical, colonoseopy and biopsy data of 93 inpatients in West China Hospital, Sichuan University with colorectal ulcers were reviewed retrospectively. Results： Ulcerative colitis （UC）, intestinal tuberculosis, ischemic colitis, solitary ulcer of colorectum, Crohn＇s disease （CD）, infectious colitis, internal bemorrhoid/post-polypectomy and malignant lymphoma were commonly seen among colorectal ulcers. The sensitivity of various diagnostic methods was： clinical diagnosis 33.396, biopsy 46.296, celonoseopy 61.396, celonoscopy plus biopsy 73.1%. UC was frequently seen as diffuse, irregular superficial small ulcers; ulcers of intestinal tuberculosis were mostly annulus; cobblestone appearance was commonly seen in CD; ischemic colitis was segmental and having clear demarcation with normal mucosa. Crypt abscess was commonly found in UC; dysplastic lymphocytos were seen in malignant lymphoma and could be confirmed immunohistocbemically; granuloma with caseous necrosis and positive acidfast bacilli was characteristic in intestinal tuberculosis, whereas non-caseous granuloma could be found in both CD and intestinal tuberculosis. Conclusions： There are various causes of colorectal ulcer. Colonoseopy plus biopsy play an important role in the etiological diagnosis of colorectal ulcer and may improve diagnostic sensitivity