527例溃疡性结肠炎临床与病理分析

目的 评价临床、内镜及活检三者在溃疡性结肠炎(UC)诊断中的作用。方法 总结我院10年间经肠镜诊断为UC的病例，分析其临床、内镜表现及部分活检资料。结果 527例确诊为UC，其中误诊34例，结肠镜诊断正确率为93．9％。UC临床主要表现为腹泻(88％)、粘液脓血便(52％)。结肠镜表现以粘膜充血水肿(94％)、糜烂溃疡(75％)最多见，病变部位以直、乙结肠为主(51％)，呈弥漫性、连续性分布。活检特征性表现为炎症程度重(49％)，固有层弥漫性混合性炎细胞浸润(76％)、杯状细胞减少(71％)、隐窝扭曲(63％)、萎缩(47％)、隐窝炎(45％)、隐窝脓肿(36％)及绒毛状表面(39％)。结论 UC的诊断应强调临床、内镜及活检相结合。

Clinical and pathological analysis of 527 cases of ulcerative colitis

Objective To evaluate the diagnostic role of clinical feature,colonoscopy and biopsy in ulcerative colitis.Methods The cases of ulcerative colitis from 1991 to 2000 diagnosed colonoscopically were retrospectively studied and all data from clinical manifestation,endoscopy and partial biopsy were analyzed.Results In 561 cases of ulcerative colitis diagnosed by colonoscopy,527 cases were confirmed as UC and 34 cases were misdiagnosed.The correct diagnostic rate of colonoscopy was 93.9%.The common clinical manifestations were diarrhea(88%) and bloody mucopurulent stool(52%).The common colonoscopic findings were mucosal edema,erythema(94%),erosion and ulcer(75%).Proctosigmoiditis was found in 51%.There are seven characteristic features including diffusive mixed inflammatory infiltration in lamina propria(76%),goblet cell depletion(71%),crypt distorted(63%),crypt atrophy(47%),cryptitis (45%),crypt abscess (36%),villiform surface(39%).Conclusion The diagnosis of ulcerative colitis must be made by combination of clinical manifestation,colonoscopic finding and biopsy histology.