血吸虫肠病的内镜诊断及病理特征

目的 探讨血吸虫肠病的内镜表现及病理特征,以引起对血吸虫肠病的重视,减少漏诊和误诊.方法 回顾性分析72例血吸虫肠病的大肠镜观察结果并结合病史、组织病理学检查分析血吸虫肠病的内镜诊断和组织学特征.结果 内镜下表现为急性肠炎型16例;慢性肠炎型27例;肠黏膜兼有急性和慢性炎症改变,称之为混合型肠炎,共29例.急性肠炎型的病理特征为大量嗜酸性粒细胞浸润,伴有未钙化的虫卵沉积;慢性型者则有大量淋巴细胞和浆细胞浸润,黏膜下纤维化,伴有已钙化的虫卵沉积;混合型肠炎则兼有上述2型的组织病理学表现.并发结直肠癌5例.在外院误诊为溃疡性结肠炎7例,回盲部肿瘤5例,肠结核2例.结论 血吸虫肠病可分为急性、慢性与混合型结直肠炎3型,混合型血吸虫肠病是区别于急性和慢性血吸虫肠病的又一重要类型.内镜检查加多部位多组织活检发现虫卵沉积是诊断血吸虫肠病的重要方法.

Endoscopic and hispathological characteristics of the intestinal schistosomiasis

Objective To report the endoscopic and hispathology characteristics of the intestinal schistosomiasis, and arose enough attention to avoid missed or misdiagnosis. Methods Clinical and endoscopic and hispathology data of the intestinal schistosomiasis in 72 patients were included in this study with Olympus CF-240 colonoscopy and biopsy. Results Endoscopic appearance showed acute enteritis in 16 cases, chronic enteritis in 27 cases and a mixed type of acute and chronic enteritis in 29 cases. In acute enteritis ova were deposited intactly with lots of eosinocyte infiltration, in chronic enteritis ova were calcified and deposited with lots of lymphocytes, plasma cells infiltration and submucosal fibrosis, while in the mixed type enteritis had both acute and chronic histopathologic appearence. Five of 72 cases were found colorectal cancer simultaneously. And 14 of 72 patients had misdiagnostic history,including ulcerative colitis 7 cases, ileocecum cancer 5 cases, and colonrectal tuberculosis 2 cases. Conclusion Intestinal schistosomiasis is classified into three types of enteritis acute,chronic and the mixed type, the latter was an important and indepent type. Colonscopy findings and repeated biopsy from the suspected lesions were essential for getting correct diagnosis.