本文選題：回盲部潰瘍　切入點：潰瘍性結(jié)腸炎　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:回顧分析我院回盲部良性病變中潰瘍患者的住院資料,探討近年來回盲部潰瘍患者住院病例的特點,加以總結(jié),旨在為回盲部潰瘍的診斷,鑒別診斷及治療提供借鑒。方法:收集2013年11月到2015年5月在我院消化科內(nèi)鏡中心行結(jié)腸鏡檢查發(fā)現(xiàn)的回盲部良性病變,篩選出鏡下表現(xiàn)為潰瘍的病例,就其臨床特征、內(nèi)鏡及病理檢查、影像學(xué)及特殊檢查,治療及隨訪情況等對回盲部潰瘍病例進行回顧性總結(jié)分析。重點探討各類疾病的臨床表現(xiàn)、實驗室檢查、內(nèi)鏡及活檢結(jié)果、治療及轉(zhuǎn)歸。結(jié)果:腸鏡下發(fā)現(xiàn)的回盲部良性病變143例中,潰瘍性病變有41例,其中非特異性潰瘍18例(43.9%),內(nèi)鏡結(jié)合活檢檢出率為94.4%,形態(tài)整齊或局限,大部分病例可經(jīng)抗炎、培菲康及谷參腸安等對癥治療后緩解。潰瘍性結(jié)腸炎10例(24.4%),內(nèi)鏡結(jié)合活檢檢出率為90%,鏡下表現(xiàn)為彌漫性充血糜爛并淺潰瘍形成,病變范圍廣泛,重度活動期者可累及全結(jié)腸,經(jīng)艾迪莎及激素治療后癥狀緩解。腸結(jié)核9例(22.0%),多有腹瀉,并伴發(fā)熱、體重減輕,右下腹壓痛陽性率高.潰瘍鏡下表現(xiàn)為不規(guī)則凹陷形節(jié)段性潰瘍,呈環(huán)型發(fā)展。5例內(nèi)鏡活檢組織病理檢查診斷腸結(jié)核,診斷率為55.6 %, 3例試驗性抗結(jié)核治療后有效支持診斷�？肆_恩病4例(9. 76%) , 2例便血,內(nèi)鏡結(jié)合活檢檢出率為25%,鏡下表現(xiàn)為沿腸壁縱行節(jié)段性潰瘍,病變連續(xù),呈鋪路石樣改變。其中1例診斷性治療后隨訪證實,2例復(fù)查腸鏡潰瘍病變好轉(zhuǎn)。41例回盲部潰瘍患者中,完善CT檢查的33例,20例有陽性發(fā)現(xiàn)。胸部X線檢查中,2例患者發(fā)現(xiàn)纖維增值性肺結(jié)核,為腸結(jié)核的確診提供了依據(jù)。9例腸結(jié)核患者中,完善結(jié)核感染T細胞斑點試驗(T-SPOT)檢查8例,結(jié)果為陽性者6例,陽性率高達75%。本組4例確診為克羅恩病的患者中,3例完善炎癥性腸病血清學(xué)檢查,陽性者2例。此2例按克羅恩病治療后病情好轉(zhuǎn)。結(jié)論:1.潰瘍性結(jié)腸炎內(nèi)鏡及活檢診斷率高,其鏡下特點為彌漫性潰瘍,多數(shù)潰瘍由從直腸發(fā)展至回盲部,病變呈連續(xù)性。非特異性潰瘍多數(shù)經(jīng)抗炎,谷參腸胺及培菲康治療有效。腸結(jié)核及克羅恩病內(nèi)鏡及活檢診斷率低,診斷性抗結(jié)核治療對二者的鑒別有重要意義。2.腸結(jié)核潰瘍多為不規(guī)則凹陷形節(jié)段性潰瘍,呈環(huán)型發(fā)展,潰瘍表面及周圍黏膜可有息肉樣增生結(jié)節(jié)�？肆_恩病的潰瘍多為沿腸壁縱行節(jié)段性潰瘍,病變連續(xù)。增生結(jié)節(jié)多見于腸結(jié)核,鋪路石樣改變及管腔狹窄多見于克羅恩病。3.腸結(jié)核與克羅恩病的鑒別診斷仍為一個難題,特異性血清檢查,如T-spot、炎癥性腸病抗體檢查對腸結(jié)核與克羅恩病的鑒別診斷發(fā)揮著重要作用。同時應(yīng)繼續(xù)尋找一種特異性指標(biāo)輔助回盲部潰瘍的診斷及鑒別診斷。
[Abstract]:Objective: to analyze retrospectively the clinical data of patients with ileocecal ulcer in our hospital, to explore the characteristics of the patients with ileocecal ulcer in recent years, and to summarize the characteristics of the cases, in order to diagnose ileocecal ulcer. Methods: from November 2013 to May 2015, we collected the benign ileocecal lesions from November 2013 to May 2015, and screened out the patients with ulcers under endoscopy. Endoscopic and pathological examination, imaging and special examination, treatment and follow-up were used to summarize and analyze retrospectively the cases of ileocecal ulcer, with emphasis on the clinical manifestations, laboratory examination, endoscopy and biopsy results of various diseases. Results: among 143 cases of ileocecal benign lesions found under enteroscopy, there were 41 cases of ulcerative lesions, of which 18 cases were nonspecific ulcers. The detection rate of endoscopic biopsy was 94.4%. 10 cases of ulcerative colitis were treated with 24. 4% of ulcerative colitis. The detection rate of endoscopy combined with biopsy was 90%. Under microscope, diffuse hyperemia and shallow ulceration were observed, with a wide range of lesions. The patients with severe active stage could be involved in the whole colon. After treatment with Adisha and hormone, the symptoms were alleviated in 9 cases of intestinal tuberculosis with diarrhea, fever, weight loss, high positive rate of right lower abdomen tenderness, and irregular hollow segmental ulcers under endoscopy. The diagnosis rate of intestinal tuberculosis was 55.6, 3 cases of experimental anti-tuberculosis treatment were effective, 4 cases of Crohn's disease (4 cases), 2 cases of hematochezia (2 cases), the diagnosis rate of intestinal tuberculosis was 55.6%, the diagnosis rate was 55.6%, the diagnosis was effective after experimental anti-tuberculosis treatment, 4 cases were Crohn's disease. The detectable rate of endoscopic biopsy was 25. The findings were as follows: longitudinal segmental ulcers along the wall of the intestine, the lesions were continuous, and the lesions presented as paving stone changes. One case was followed up after diagnostic treatment and 2 cases were confirmed to have improved the ulceration of ileocecal ulcer in 1 case, and in 41 cases of ileocecal ulcer, there were 41 cases of ileocecal ulcer. Among 33 cases of CT examination, 20 cases were positive, 2 cases of fibroblast pulmonary tuberculosis were found in chest X-ray examination, which provided basis for the diagnosis of intestinal tuberculosis in 9 cases. T-SPOT (T cell spot test) for tuberculosis infection was completed in 8 cases, 6 cases were positive, the positive rate was as high as 75%. In this group of 4 patients diagnosed as Crohn's disease, 3 cases were perfect in the serological examination of inflammatory bowel disease. Two cases were positive. These two cases were improved after treatment with Crohn's disease. Conclusion 1.The diagnostic rate of endoscopy and biopsy of ulcerative colitis is high. The characteristic of the ulcerative colitis is diffuse ulcer, most of which develop from rectum to ileocecal region. The lesions were continuous. Most of the nonspecific ulcers were treated with anti-inflammatory drugs. The diagnosis rate of endoscopy and biopsy of intestinal tuberculosis and Crohn's disease was low. Diagnostic antituberculous therapy is of great significance in differentiating the two. 2. Intestinal tuberculosis ulcers are mostly irregular and concave segmental ulcers, which develop in annular type. The ulcer surface and surrounding mucosa may have polypoid hyperplastic nodules. Crohn's disease ulcers are mostly along the intestinal wall longitudinal segment ulcers, the lesions are continuous. Hyperplastic nodules are more common in intestinal tuberculosis, The differential diagnosis of intestinal tuberculosis and Crohn's disease is still a difficult problem. For example, the detection of antibodies to inflammatory bowel disease plays an important role in the differential diagnosis of intestinal tuberculosis and Crohn's disease. At the same time, we should continue to look for a specific index to assist the diagnosis and differential diagnosis of ileocecal ulcer.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574

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