本文選題：超聲內(nèi)鏡 + 腸道潰瘍�。� 參考：《南方醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景與目的 近年來隨著國內(nèi)內(nèi)鏡檢查開展范圍的擴(kuò)大,具有腹痛、腹瀉、便血等腹部癥狀的患者接受內(nèi)鏡檢查的比率越來越高,可早期發(fā)現(xiàn)腸道病變諸如腸道潰瘍,從而及早得到有效的治療。腸道潰瘍可由多種疾病導(dǎo)致,可通過各種方法確診或排除。但仍有部分疾病因各方面表現(xiàn)相似之處較多而難以相互鑒別,其中克羅恩病、腸道淋巴瘤、腸道結(jié)核有較大的鑒別難度。 克羅恩病(Crohn's disease, CD)是一種病因尚未完全清楚的慢性非特異腸道炎性疾病,近年來在我國已成為消化系統(tǒng)的常見病。該病臨床特點(diǎn)為：全腸道累及,病程呈發(fā)作與緩解交替,并可有多種腸外并發(fā)癥。常見于青少年。內(nèi)鏡下表現(xiàn)為節(jié)段性、非對稱性分布的粘膜炎癥,可有縱行或阿弗他潰瘍,潰瘍間粘膜可呈正常表現(xiàn)或呈鵝卵石樣增生,亦可見瘺管、膿腫、腸狹窄等并發(fā)癥。因該病臨床表現(xiàn)的多樣化,現(xiàn)仍未確定診斷金標(biāo)準(zhǔn),需結(jié)合各種臨床資料才能確診,故該病在我國診治率較低。 原發(fā)性腸道淋巴瘤(Lymphoma, L)起源于腸壁粘膜下層的淋巴組織,可向腸腔內(nèi)破潰形成腸道潰瘍,腸壁周圍淋巴結(jié)腫大,以及形成局部腫塊。亦可出現(xiàn)全身轉(zhuǎn)移,造成發(fā)熱、消瘦、盜汗等全身癥狀甚至惡病質(zhì)。結(jié)直腸是原發(fā)性胃腸道淋巴瘤較罕見的發(fā)病部位。本病內(nèi)鏡下的潰瘍型多表現(xiàn)為大小不等、形狀不規(guī)則的多發(fā)潰瘍,部位不定,缺乏特異性。鉗夾活檢則難以取到病變組織,且多數(shù)結(jié)直腸淋巴瘤患者的初期癥狀無典型性且多為輕度,體征不明顯,因此在臨床上更容易漏診誤診。 我國的結(jié)核病(Tuberculosis, TB)患病人數(shù)目前為世界第二位。該病以青壯年多見,女性多于男性。腸結(jié)核絕大部分繼發(fā)于肺結(jié)核,好發(fā)于回盲部。分為3種類型：潰瘍型、增殖型及混合型。其內(nèi)鏡下最具特征的表現(xiàn)為環(huán)形潰瘍,回盲部多發(fā)；但病變處于早期時潰瘍較小以及后期融合為巨大潰瘍后無法辨認(rèn)其是否呈環(huán)形,且潰瘍之間粘膜正常。癥狀上患者可有腹痛、腹瀉及結(jié)核全身中毒癥狀。以上均容易與克羅恩病互相誤診。常用的各種輔助檢查特異性均較低。懷疑腸結(jié)核后,一般需進(jìn)行較長時間的診斷性抗結(jié)核治療后復(fù)查內(nèi)鏡視潰瘍愈合情況判定是否為腸結(jié)核。其診斷耗時較長。 綜上所述,克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核三病因起病緩慢一般難以得到較有鑒別意義的病史；癥狀上均有腹痛、便血、消瘦、營養(yǎng)不良,亦可有發(fā)熱；體征上無明顯差別,都有腹部壓痛、腹塊等,克羅恩病與腸道結(jié)核均可出現(xiàn)瘺管、腹腔膿腫等并發(fā)癥；各項輔助檢查特異性均不高。再加上有使用英孚利昔單抗治療的克羅恩病患者繼發(fā)結(jié)核病、淋巴瘤的報道,導(dǎo)致三病的鑒別診斷成為內(nèi)鏡醫(yī)師的重點(diǎn)難題之一。 目前內(nèi)鏡檢查成為腸道潰瘍的常規(guī)檢查手段。但內(nèi)鏡僅可對病變消化道的粘膜表面進(jìn)行檢查,探明潰瘍大小及分布。而三病的內(nèi)鏡下表現(xiàn)常不典型,尤其是早期患者,常僅僅表現(xiàn)為非特異的單發(fā)或多發(fā)潰瘍；克羅恩病及腸道結(jié)核常多發(fā)于回盲部；都可有腸狹窄、梗阻等并發(fā)癥；另外克羅恩病、腸道結(jié)核因具有特異性的非干酪樣及干酪樣肉芽腫病理活檢檢出率低、結(jié)直腸淋巴瘤因病變較深深挖活檢難度較大且需要冒一定的穿孔風(fēng)險,三病內(nèi)鏡下鉗夾活檢結(jié)果多為粘膜非特異性炎癥,故內(nèi)鏡下活檢難以提供較好的三病早期鑒別診斷價值,使三病的早期鑒別診斷難度較大。三病的治療方法從原則上即各不相同,一旦誤診必然導(dǎo)致誤治,其冗長的診斷周期及相應(yīng)的診斷成本可對患者及其家庭造成生理、心理及經(jīng)濟(jì)上的重大負(fù)擔(dān)。故三病的早期診斷可從多方面極大改善患者的生存質(zhì)量。 超聲技術(shù)已有數(shù)十年的應(yīng)用歷史。體表超聲對增厚的腸壁、腸外腫大淋巴結(jié)、腹水以及腸腔狹窄有很好的探查效果,在肛周進(jìn)行檢查尚可探查瘺管和膿腫等腸外并發(fā)癥。超聲對該三病最具鑒別意義之處在于能夠探查患者的腸壁層次改變。因三病病理在病變早期已各不相同,故可通過其腸壁聲像改變對三病做出鑒別診斷�？肆_恩病病理主要表現(xiàn)為腸壁全層增厚,粘膜下層增厚明顯,此系管壁炎癥引起的一系列改變,包括水腫、淋巴管血管擴(kuò)張、淋巴細(xì)胞聚集,這些改變可造成粘膜下層回聲較正常粘膜下層稍低以及層次間界線稍許模糊但依舊可辨；結(jié)直腸淋巴瘤病變起源于粘膜下層,早期亦為粘膜下層增厚,但其病情進(jìn)展較快,沿腸壁長軸侵犯,且其實質(zhì)細(xì)胞密度較高,中間間質(zhì)細(xì)胞含量少,故其聲像可表現(xiàn)為層次模糊甚至消失,病變呈彌漫的低回聲且因其為低度惡性腫瘤,具有一定侵襲性,故病變�？赏黄颇c壁并侵犯周圍組織；腸道結(jié)核病變起源于粘膜層淋巴組織,粘膜層炎癥導(dǎo)致的水腫、增生滲出使其聲像表現(xiàn)為粘膜層增厚,粘膜下層可因炎癥導(dǎo)致疤痕形成而閉鎖,以及因粘膜層的擠壓而變窄及聲像上顯示模糊,由于其炎癥較為局限,層次一般清晰可辨。但體表超聲因易受干擾、操作要求高,國內(nèi)較少依靠體表超聲診斷三病。 超聲內(nèi)鏡(Endoscopic ultrasonography, EUS)融合了超聲及內(nèi)鏡的特點(diǎn),在內(nèi)鏡下觀察消化道管壁粘膜病變的同時,可對消化道管壁及管壁外病變進(jìn)行實時超聲掃描,有效避免了腹壁脂肪、腸腔空氣的干擾,且可對腸壁層次病變更加近距離的觀察,得到更準(zhǔn)確的信息。但目前在我國超聲內(nèi)鏡開展范圍較小,關(guān)于超聲內(nèi)鏡診斷克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核管壁病變的數(shù)據(jù)均較少。鑒于以上研究背景,本次研究回顧了最近5年內(nèi)南方醫(yī)院消化內(nèi)鏡中心351例疑似克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核所致腸道潰瘍的內(nèi)鏡、超聲內(nèi)鏡及臨床資料,總結(jié)三病超聲內(nèi)鏡下診斷標(biāo)準(zhǔn),并計算其診斷率等數(shù)據(jù),探討超聲內(nèi)鏡對克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核三病的診斷及鑒別診斷價值。 患者資料和檢查方法 1、臨床資料：2008年1月-2013年6月,于廣州南方醫(yī)院消化內(nèi)鏡中心所檢查內(nèi)鏡下發(fā)現(xiàn)腸道潰瘍者,經(jīng)各種方法排除除克羅恩病、腸道淋巴瘤、腸道結(jié)核的其它疾病,剩余者行腸道超聲內(nèi)鏡檢查,最后經(jīng)各種方法確診,且臨床數(shù)據(jù)完整者共351例。確診方法為試驗性治療、活檢病理、手術(shù)病理、大塊黏膜剝離活檢、淋巴結(jié)切除活檢及B超引導(dǎo)下淋巴結(jié)穿刺活檢。 2、檢查方法及術(shù)前準(zhǔn)備：超聲內(nèi)鏡于電子結(jié)腸鏡檢查后即刻或1周內(nèi)進(jìn)行。每位患者檢查前均簽署超聲腸鏡檢查知情同意書,患者為左側(cè)臥位,根據(jù)需要變換體位。在病灶處及病灶周圍進(jìn)行超聲內(nèi)鏡掃描。根據(jù)病灶的不同情況分別采用脫氣水充盈法、直接接觸法或水囊法+脫氣水充盈法對病灶進(jìn)行掃描。每例行超聲內(nèi)鏡檢查時間10～30mim所有患者檢查時及檢查后除偶見輕度腹痛外未見其它并發(fā)癥發(fā)生； 3、圖像評閱：由南方醫(yī)院消化內(nèi)鏡中心資深超聲內(nèi)鏡醫(yī)師對內(nèi)鏡圖像及超聲下圖像結(jié)果進(jìn)行評閱,仔細(xì)觀察管壁及其旁組織結(jié)構(gòu)影像變化并記錄：管壁全層厚度、主要增厚層次、病變回聲高低、各層次邊界是否清晰、有無探及粘膜下層內(nèi)直徑大于2mm的脈管結(jié)構(gòu)、病變是否突破管壁、有無探及竇道、瘺管、膿腫、管壁旁腫大淋巴結(jié)以及淋巴結(jié)是否融合；同一患者不同節(jié)段的病灶以病變最重處的數(shù)據(jù)計入。 結(jié)果 1、克羅恩病的超聲內(nèi)鏡表現(xiàn)：病變處管壁以粘膜下層增厚為主,各層次結(jié)構(gòu)清晰可辨,部分邊界模糊；病變回聲較正常粘膜下層回聲稍低；共214例克羅恩病患者、無結(jié)直腸淋巴瘤患者及腸道結(jié)核患者符合該表現(xiàn),在各組所占比例分別為90.7%、0%、0%；克羅恩病組與結(jié)直腸淋巴瘤組(χ2=194.846,P0.001)、克羅恩病組與腸道結(jié)核組(χ2=150.891,P0.001)比較均有差異；克羅恩病組符合比例明顯高于其它2組； 2、結(jié)直腸淋巴瘤的超聲內(nèi)鏡表現(xiàn)：病變處管壁層次消失而無法判斷增厚層次,各層次結(jié)構(gòu)消失；病變回聲呈均質(zhì)彌漫低回聲；共3例克羅恩病患者、48例結(jié)直腸淋巴瘤患者、4例腸道結(jié)核患者符合本表現(xiàn),在各組所占比例分別為1.3%、81.4%、11.4%；結(jié)直腸淋巴瘤組與克羅恩病組(χ2=211.702,P0.001)、結(jié)直腸淋巴瘤組與腸道結(jié)核組(χ2=43.460,P0.001)比較均有顯著性差異；結(jié)直腸淋巴瘤組符合比例明顯高于其它2組 3、腸道結(jié)核的超聲內(nèi)鏡表現(xiàn)：病變處管壁以粘膜層增厚為主,粘膜下層變窄、模糊,或未見明顯增厚,各層次間界限清晰可辨；病變呈稍高或高回聲；4例克羅恩病患者、2例結(jié)直腸淋巴瘤患者、25例腸道結(jié)核患者符合該表現(xiàn),所占比例為1.7%、3.4%、71.4%；腸道結(jié)核組與克羅恩病組(x2=155.103,P0.001)、腸道結(jié)核組與結(jié)直腸淋巴瘤組(χ2=49.673,P0.001)比較均有顯著性差異；腸道結(jié)核組符合比例明顯高于其它2組。 4、本研究中超聲內(nèi)鏡對克羅恩病診斷符合率、敏感性、特異性分別為91.5%,90.7%,93.0%；對結(jié)直腸淋巴瘤診斷符合率、敏感性、特異性分別為95.2%,81.4%,97.9%；對腸道結(jié)核診斷符合率、敏感性、特異性分別為94.5%,71.4%,97.5%。 結(jié)論 1.克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核三病的超聲內(nèi)鏡表現(xiàn)有較大差異性： 1)克羅恩病的超聲內(nèi)鏡表現(xiàn)：病變處管壁以粘膜下層增厚為主,各層次結(jié)構(gòu)清晰可辨,部分邊界模糊；病變回聲較正常粘膜下層回聲稍低； 2)結(jié)直腸淋巴瘤的超聲內(nèi)鏡表現(xiàn)：病變處管壁層次消失而無法判斷增厚層次,各層次間界限模糊不清,部分層次結(jié)構(gòu)消失；病變回聲呈均質(zhì)彌漫低回聲； 3)腸道結(jié)核的超聲內(nèi)鏡表現(xiàn)：病變處管壁以粘膜層增厚為主,粘膜下層變窄、模糊,或未見明顯增厚,各層次間界限清晰可辨；病變呈稍高回聲； 2、超聲內(nèi)鏡可清晰顯示管壁病變及管壁外并發(fā)癥,包括瘺管、竇道、膿腫、腹水等； 3、本研究中超聲內(nèi)鏡對三病的診斷符合率均達(dá)到90%以上；超聲內(nèi)鏡對克羅恩病、結(jié)直腸淋巴瘤、腸道結(jié)核鑒別診斷有較高價值,可對病變進(jìn)行較準(zhǔn)確的術(shù)前評估,為外科治療提供有價值的信息；有效縮短診斷周期及成本,使患者早期接受正確的治療。
[Abstract]:Research background and purpose
In recent years, with the expansion of the scope of domestic endoscopy, the rate of endoscopy in patients with abdominal pain, diarrhea, and blood pressure is getting higher and higher, and early detection of intestinal lesions, such as intestinal ulcers, can be effectively treated. Intestinal ulcer can be caused by a variety of diseases and can be confirmed or excluded by various methods. However, there are still some diseases that are difficult to identify with each other because of the many similarities in each aspect. There are more difficult identification of Crohn's disease, intestinal lymphoma and intestinal tuberculosis.
Crohn's disease (CD) is a chronic nonspecific enteric inflammatory disease, which has not been fully understood. In recent years, it has become a common disease in the digestive system in our country. The clinical characteristics of this disease are all intestinal involvement, the course of the disease is alternating with remission, and there are many kinds of extra intestinal complications. The mucosal inflammation of the segmental and asymmetrical distribution of mucous membrane may have longitudinal or aphthous ulcers, the mucous membrane of the ulcers can show normal or cobblestone like hyperplasia, and the complications such as fistula, abscess, and intestinal stenosis. The diagnostic gold standard is still unconfirmed because of the diversity of clinical manifestations of the disease. It is necessary to combine various clinical data to confirm the diagnosis. Therefore, the disease is in our country. The rate of diagnosis and treatment is low.
Primary intestinal lymphoma (Lymphoma, L) originates from the lymphatic tissue of the submucosa of the intestinal wall, which can break into the intestinal cavity to form the intestinal ulcer, the lymph nodes around the intestinal wall are enlarged, and the local mass is formed. The whole body metastases can also occur, causing fever, emaciation, night sweating and even cachexia. The colorectal is a primary gastrointestinal lymphoma. The ulcerative type in the endoscopy of this disease is characterized by different sizes, irregular shapes of ulcers, indeterminate locations and lack of specificity. The biopsy of the clamp is difficult to take the pathological tissue, and the initial symptoms of most cases of colorectal lymphoma are not typical and light, and the signs are not obvious, so it is more likely to be missed clinically. Misdiagnosis.
The number of Tuberculosis (TB) in China is currently the second most common disease in the world. The disease is more common in young adults and more women than men. The vast majority of intestinal tuberculosis secondary to tuberculosis in the ileocecal region. It is divided into 3 types: ulcerative, proliferating and mixed types. In the early stage of the disease, the ulcer is small and the later fusion can not be identified if the ulcer is ring-shaped, and the mucous membrane between the ulcers is normal. The symptomatic patients can have abdominal pain, diarrhea and the symptoms of tuberculosis systemic poisoning. All of these are easily misdiagnosed with Krohn's disease. In general, it is necessary to conduct a long time of diagnostic tuberculosis treatment to check whether the endoscopic ulcer healing is intestinal tuberculosis.
To sum up, the three causes of Crohn's disease, colorectal lymphoma, and intestinal tuberculosis are generally difficult to have a more differential history of disease; symptoms include abdominal pain, blood, emaciation, malnutrition, and fever; there are no obvious differences in physical signs, abdominal pain, abdominal mass, Crohn's disease and intestinal tuberculosis, and abdominal cavity, abdominal cavity, and abdominal cavity. Complications such as abscess and other complications; the specificity of all the auxiliary examinations was not high. In addition to the secondary tuberculosis of the patients with Crohn's disease treated with infliximab, a report of lymphoma, which led to the differential diagnosis of three diseases became one of the key problems of endoscopes.
Endoscopy has become a routine examination for intestinal ulcers. However, endoscopy can only examine the mucosal surface of the digestive tract and detect the size and distribution of the ulcer. The endoscopic findings of three diseases are often untypical, especially in early patients, which are often characterized by nonspecific single or multiple ulcers; Crohn's disease and intestinal tuberculosis often occur frequently. In the ileocecal part, there are complications such as intestinal stenosis and obstruction; in addition, Crohn's disease and intestinal tuberculosis are low in the detection rate of pathological biopsy of non cheese like and caseous granuloma. Colorectal lymphoma is more difficult to biopsy because of a deeper lesion and requires a certain risk of perforation. The results of biopsy under three endoscopy are mostly sticky. Non specific inflammation of the membrane, therefore, the endoscopic biopsy is difficult to provide a good value for the early differential diagnosis of three diseases, making the early differential diagnosis of the three disease difficult. The treatment methods of three diseases are different in principle. Once the misdiagnosis inevitably leads to mistaken treatment, the long diagnosis cycle and the diagnosis cost of the phase should cause the physiology of the patients and their families. The early diagnosis of three diseases can greatly improve the quality of life of patients.
Ultrasound has a history of decades of application. Body surface ultrasound has a good effect on the thickening of the intestinal wall, enlarged lymph nodes outside the intestine, ascites and the stenosis of the intestinal cavity. It is possible to detect the external complications such as fistula and abscess in the perianal examination. The most differential significance of ultrasound to the three diseases is to detect the changes of the intestinal wall level of the patients. The pathology of three disease is different at the early stage of the lesion, so the differential diagnosis of three disease can be made through the changes in the sound image of the intestinal wall. The pathology of Crohn's disease is mainly the thickening of the whole layer of the intestinal wall, the thickening of the submucosa, and a series of changes caused by the inflammation of the wall of the tube, including edema, vasodilatation of the lymphatic tube, and lymphocyte aggregation. These changes can be made. The submucosa echo is slightly lower than that of the normal submucosa, and the boundary line is a little blurred. The lesion of colorectal lymphoma originates from the submucosa and is thickened at the early stage of the mucous membrane. However, the disease progresses rapidly, along the long axis of the intestinal wall, and its parenchyma cell density is high, and the intermediate stromal cell content is less, so its sound image is low. It can be expressed as a fuzzy or even disappearing level, with a diffuse low echo and a low malignancy with a certain invasive, so the lesion often breaks through the intestinal wall and invades the surrounding tissue; the intestinal tuberculosis lesions originate from the mucosa of the mucosa, the edema caused by mucous membrane inflammation, and the proliferation and exudation of the mucous membrane as the thickening of the mucous membrane. The submucosa can be locked in the formation of inflammation, narrowing and blurred on the sound image because of the extrusion of the mucous membrane. Because the inflammation is limited, the level is clear and distinguishable. However, the body surface ultrasound is easily disturbed, the operation is high, and the three disease is diagnosed less by the body surface ultrasound.
Endoscopic ultrasonography (EUS), which combines the characteristics of ultrasound and endoscopy, can be used to observe the mucosal lesions of the digestive canal wall under endoscopy, and can perform real-time ultrasonic scanning on the wall of the digestive tract and extramial lesions, effectively avoiding the abdominal wall fat, the interference of the air in the intestine, and the more close observation of the intestinal wall lesion. More accurate information is obtained. However, there is a small range of endoscopic ultrasonography in our country. There are few data on the diagnosis of Krohn's disease, colorectal lymphoma and intestinal tuberculosis tube wall lesions. In view of the above research background, this study reviewed 351 cases of suspected Krohn's disease and colorectal cancer in the digestive endoscopy center of southern hospital in the last 5 years. Endoscopy, endoscopic ultrasonography, and clinical data of intestinal ulcers caused by intestinal tuberculosis were used to summarize the diagnostic criteria of three diseases under ultrasonic endoscopy and to calculate the diagnostic rate. The value of endoscopic ultrasonography in the diagnosis and differential diagnosis of Crohn's, colorectal lymphoma and three diseases of intestinal tuberculosis was discussed.
Patient data and methods of examination
1, clinical data: in June -2013, January 2008, in the digestive endoscopy center of Guangzhou Nanfang Hospital, the patients with intestinal ulcer were detected by endoscopy. The other diseases were eliminated by various methods, including Crohn's disease, intestinal lymphoma and intestinal tuberculosis. The remaining patients were examined by intestinal endoscopic ultrasonography, and 351 cases were confirmed by various methods, and the total clinical data were complete. The diagnostic methods were experimental treatment, biopsy pathology, surgical pathology, large lump dissection biopsy, lymph node biopsy and lymph node biopsy under B-ultrasound guidance.
2, examination method and preoperative preparation: endoscopic ultrasonography was performed immediately after electronic colonoscopy or within 1 weeks. Each patient signed an informed consent book of ultrasonic colonoscopy before examination. The patient was a left lateral position, and the body position was changed according to the need. The ultrasound endoscopy was performed at the lesion and around the lesion. The focus was scanned by air water filling, direct contact or water bursa and degassing water filling, and every routine endoscopy time was 10 ~ 30mim for all patients and no other complications were found except for mild abdominal pain.
3, image review: a senior endoscope doctor of the southern hospital's digestive endoscopy was reviewed by a senior endoscope doctor for the image of endoscopy and ultrasound. The changes of the wall and its adjacent tissue images were carefully observed and recorded: the thickness of the wall of the tube, the main thickness of the thickening, the high and low echo of the lesion, the clarity of the boundary of each level, the submucosa and the submucosa. The internal diameter of the vascular structure is greater than 2mm. Whether the lesion breaks through the wall of the tube, the sinus, the fistula, the abscess, the lymph nodes adjacent to the wall of the tube and the fusion of the lymph nodes; the lesions of the same patient's segments are included in the data of the most serious lesions.
Result
1, the ultrasonic endoscopy of Crohn's disease: the wall of the lesion was thickened mainly by the submucosa, the structure of each level was clear and the partial boundary was blurred, and the echo of the lesion was slightly lower than that of the normal submucosa; a total of 214 cases of Crohn's disease, non colorectal lymphoma and intestinal nucleation patients were in accordance with this manifestation, and the proportion of the patients in each group was the same. 90.7%, 0%, 0%, Crohn's disease group and Colorectal Lymphoma Group (x 2=194.846, P0.001), Crohn's disease group and intestinal tuberculosis group (x 2=150.891, P0.001) were different, and the proportion of Crohn's disease group was significantly higher than that of other 2 groups.
2, the endoscopic ultrasonography of colorectal lymphoma: the disappearance of the wall level in the lesion and the disappearance of the thickening level and the disappearance of the layers; the echo was homogeneous and diffuse hypoechoic; 3 cases of Crohn's disease, 48 cases of colorectal lymphoma and 4 cases of intestinal tuberculosis were conformed to this performance, and the proportion in each group was 1.3%, 81.4%, 11, respectively. .4%, colorectal lymphoma group and Crohn's disease group (x 2=211.702, P0.001), colorectal lymphoma group and intestinal tuberculosis group (x 2=43.460, P0.001) were significantly different, the proportion of colorectal lymphoma group was significantly higher than the other 2 groups.
3, the endoscopic ultrasonography of intestinal tuberculosis: the wall of the lesion was thickened mainly with the thickening of the mucous layer, the submucosa narrowed, blurred, or no obvious thickening, and the boundaries were clearly distinguishable; the lesions were slightly higher or hyperechoic; 4 cases of Crohn's disease, 2 cases of colorectal lymphoma and 25 cases of intestinal tuberculosis were conformed to this performance, the proportion accounted for 1.7%. 3.4%, 71.4%, the intestinal tuberculosis group and the Crohn's disease group (x2=155.103, P0.001), the intestinal tuberculosis group and the Colorectal Lymphoma Group (x 2=49.673, P0.001) were significantly different, the proportion of intestinal tuberculosis group was significantly higher than the other 2 groups.
4, the diagnostic coincidence rate, sensitivity, specificity of endoscopic ultrasonography to Crohn's disease were 91.5%, 90.7%, 93%, and the diagnostic coincidence rate, sensitivity and specificity of colorectal lymphoma were 95.2%, 81.4%, 97.9%, respectively, and the diagnostic coincidence rate of intestinal tuberculosis, sensitivity and specificity were 94.5%, 71.4%, 97.5%., respectively.
conclusion
1. there were great differences in endoscopic ultrasonography in Crohn's disease, colorectal lymphoma, and intestinal tuberculosis three diseases.
1) the ultrasonic endoscopy of Crohn's disease: the wall of the lesions was thickened mainly by the submucosa, the structure of each level was clear and the partial boundary was blurred, and the echo of the lesion was slightly lower than the echo of the normal submucosa.
2) endoscopic ultrasonography of colorectal lymphoma: the layer of the wall of the lesions disappeared and the thickening level could not be judged. The boundaries between the various levels were blurred, some of the layers disappeared, and the echoes were homogeneous and diffuse hypoechoic.
3) endoscopic ultrasonography of intestinal tuberculosis: the wall of the lesion was thickened with the thickening of the mucous layer, the submucosa narrowed, blurred, or no obvious thickening, and the boundaries between the various levels were clearly distinguishable.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R574

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