本文選題：回盲部病變 + 臨床分析��； 參考：《皖南醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：回顧性分析251例回盲部病變，總結(jié)回盲部各種病變的種類、分布、臨床特點、病理特征等，評估結(jié)腸鏡及病理組織學(xué)檢查對回盲部潰瘍性病變的確診價值，重點分析腸鏡下各類型回盲部潰瘍的特點，以加強(qiáng)對回盲部各疾病的認(rèn)識，為臨床回盲部疾病的診療工作提供幫助。 材料與方法：收集我院自2010年12月至2013年12月腸鏡檢查中檢出的251例回盲部病變的患者，所有患者均行腸鏡檢查，采用PENTAX公司EC-3870Fk、EC-3890Fi電子結(jié)腸鏡，所有病例均檢查至回盲部。對其性別、年齡、臨床特點、內(nèi)鏡下診斷及病理學(xué)檢查進(jìn)行總結(jié)分析。重點探討回盲部潰瘍性疾病如潰瘍性結(jié)腸炎、克羅恩病、腸結(jié)核、惡性淋巴瘤、結(jié)腸癌（潰瘍型）的診斷及鑒別診斷等。采用SPSS19.0標(biāo)準(zhǔn)化數(shù)據(jù)庫進(jìn)行統(tǒng)計學(xué)處理。 結(jié)果：1.本組資料中男性140例，女性111例，比例為1.26:1，年齡15歲～84歲，平均年齡53.37±15.06歲，臨床表現(xiàn)以腹痛、腹瀉、便血、腹部包塊為多見。 2.病變部位和性質(zhì)：病變位于盲腸129例(51.39%),回盲瓣33例(13.15%),升結(jié)腸始端例34例(13.55%),回腸末端31例(12.35%),闌尾開口24例(9.56%),如病變累及2個或2個以上部位稱為多部位,有38例。 3.病理檢查結(jié)果：回盲部炎癥71例，其中行病理活組織檢查提示為黏膜慢性炎癥者為56例，余15例未行病理檢查；回盲部息肉57例，炎性及增生性息肉43例、腺瘤性息肉14例；回盲部憩室20例，回盲部癌35例，以中低分化腺癌為主。淋巴瘤9例，8例為彌漫性大B細(xì)胞淋巴瘤，1例為套細(xì)胞淋巴瘤。潰瘍性結(jié)腸炎19例，克羅恩病9例，腸結(jié)核2例，非特異性潰瘍29例。 4.在確診的病例中，回盲部潰瘍性疾病包括潰瘍性結(jié)腸炎（多為全結(jié)腸炎累及回盲部）、克羅恩病、腸結(jié)核、淋巴瘤、腸癌共74例。腹痛、腹瀉、發(fā)熱在回盲部潰瘍性疾病的比較中，統(tǒng)計學(xué)上無明顯差異。其他癥狀如便血、腹部包塊、消瘦在回盲部潰瘍性疾病的比較中，差異有統(tǒng)計學(xué)意義。其中，便血以潰瘍性結(jié)腸炎多見，腹部包塊和消瘦以回盲部癌及惡性淋巴瘤多見。 5.內(nèi)鏡結(jié)合病理活檢對回盲部潰瘍性病變的鑒別診斷具有重要價值。對于回盲部癌、潰瘍性結(jié)腸炎的診斷價值極高，但對于克羅恩病及腸結(jié)核的鑒別診斷仍較困難。 6.不同疾病的潰瘍具有不同的內(nèi)鏡下特點。潰瘍性結(jié)腸炎鏡下全結(jié)腸彌漫性水腫，糜爛，潰瘍，包括回盲部充血，糜爛，糜爛及潰瘍的末端回腸�？v行裂隙狀潰瘍?yōu)榭肆_恩病的特點。潰瘍伴單一腫塊形成者多見于回盲部癌。仍有少數(shù)病例（淋巴瘤、腸結(jié)核、闌尾粘液囊腺癌）內(nèi)鏡及活檢仍無法確診，最終通過術(shù)后病理及試驗性治療后確診。 結(jié)論：回盲部病變以炎性病變占首位，息肉其次，回盲部癌第三，潰瘍性結(jié)腸炎、腸結(jié)核、克羅恩病及淋巴瘤等均不多見。性別上，男性較女性略多，平均年齡在50歲左右。從發(fā)病部位來看，病變發(fā)生于盲腸最多，靠近回盲部的升結(jié)腸始端其次，闌尾處最少見�；孛げ繚冃约膊〉呐R床表現(xiàn)上呈現(xiàn)非特異性。多數(shù)表現(xiàn)為腹痛、腹瀉、排便習(xí)慣改變、便血等，惡性腫瘤還有腹部包塊、消瘦等。內(nèi)鏡和內(nèi)鏡活檢對重癥潰瘍性結(jié)腸炎、結(jié)腸直腸癌（潰瘍）有較高的診斷價值。但對于腸結(jié)核，Crohn氏病和惡性淋巴瘤的診斷價值不高，，鑒別較困難。由于鏡下病理檢查只能局限的從黏膜取材進(jìn)行活檢,無法觀察到腸壁全層及病變的全貌,也不易發(fā)現(xiàn)一些特征性病變。因此，對于回盲部潰瘍性病變，雖然內(nèi)鏡下潰瘍的典型形態(tài)學(xué)特征不同，但一次活檢并不能完全確診，這就導(dǎo)致了疾病的漏診和誤診，所以，總體來說，我們需根據(jù)臨床表現(xiàn)、內(nèi)鏡活檢病變特征結(jié)合在一起綜合分析來提高回盲部病變病因診斷率。
[Abstract]:Objective: To review 251 cases of ileocecal lesions, summarize the types, distribution, clinical features and pathological features of the ileocecal lesions, evaluate the diagnostic value of colonoscopy and histopathology for the ulcerative lesions of the ileocecal region, and focus on the characteristics of all types of ileocecal ulceration under the enteroscopy, so as to strengthen the understanding of all the diseases in the ileocecal part. The diagnosis and treatment of the clinical ileocecal disease is helpful.
Materials and methods: 251 cases of ileocecal lesions were detected in our hospital from December 2010 to December 2013. All the patients were examined by enteroscopy, using PENTAX company EC-3870Fk and EC-3890Fi electron colonoscopy. All cases were examined to the ileocece. The sex, age, clinical characteristics, endoscopic diagnosis and pathological examination were performed. The diagnosis and differential diagnosis of ulcerative diseases such as ulcerative colitis, Crohn's disease, intestinal tuberculosis, malignant lymphoma, colon cancer (ulcerative type) and so on. The SPSS19.0 standardized database was used for statistical treatment.
Results: 1. in 1. of the data, there were 140 males and 111 females, the proportion was 1.26:1, the age was 15 years to 84 years old, the average age was 53.37 + 15.06 years. The clinical manifestations were abdominal pain, diarrhea, blood, and abdominal mass.
2. lesion location and nature: the lesions were located in 129 cases (51.39%) of cecum, 33 cases of ileocecal valve (13.15%), 34 cases (12.35%) at the beginning of ascending colon, 31 cases (12.35%) at the distal ileum and 24 cases (9.56%) of appendix opening, such as lesions involving 2 or more than 51.39% sites, and there were 38.
3. pathological examination results: 71 cases of ileocecal inflammation, including 56 cases of chronic inflammation of mucous membrane and 15 cases without pathological examination, 57 cases of ileocecal polyps, 43 cases of inflammatory and proliferative polyps, 14 adenomatous polyps, 20 cases of ileocecal diverticulum and 35 cases of ileocecal carcinoma, 9 cases of lymphoma and 8 lymphoma, 9 cases of lymphoma, 8. Diffuse large B cell lymphoma, 1 case of mantle cell lymphoma, 19 cases of ulcerative colitis, 9 cases of Crohn's disease, 2 cases of intestinal tuberculosis, 29 cases of non-specific ulcers.
4. in the confirmed cases, the ulcerative disease of the ileocecal region including ulcerative colitis (mostly colitis involving ileocecal), Crohn's disease, intestinal tuberculosis, lymphoma, and colon cancer, 74 cases, abdominal pain, diarrhea, and fever in the ileocecal ulcer disease, statistically indistinct. Other symptoms such as blood, abdominal mass, and emaciation in the ileocecal part There were significant differences in the comparison of ulcerative diseases. Among them, there were many cases of ulcerative colitis, abdominal mass and emaciation in the cases of ileocecal and malignant lymphoma.
5. endoscopy combined with pathological biopsy is of great value in the differential diagnosis of ulcerative diseases in the ileocecal region. It is of high value for the diagnosis of ileocecal carcinoma and ulcerative colitis, but it is still difficult for the differential diagnosis of Crohn's disease and intestinal tuberculosis.
6. the ulcers of different diseases have different endoscopic characteristics. Diffuse edema, erosion, ulcers, including hyperemia, erosion, erosion and ulcers at the end of the ileocecal region. The diagnosis of tumor, biopsy and biopsy of the appendiceal mucinous cystadenocarcinoma is still undiagnosed.
Conclusion: the lesions of the ileocecal region were the first of inflammatory lesions, and the polyps were second, third of the ileocecal carcinoma, ulcerative colitis, intestinal tuberculosis, Crohn's disease and lymphoma were not common. In sex, the male was a little more than the female, the average age was about 50 years. The most rare appendix. The clinical manifestations of ulcerative disease in the ileocecal region are nonspecific. Most of them are abdominal pain, diarrhea, changes in bowel habits, blood and so on, malignant tumor and abdominal mass, emaciation, etc.. Endoscopy and endoscopic biopsy are of high diagnostic value for severe ulcerative colitis, colorectal cancer (ulcers), but for intestinal tuberculosis, Croh The diagnostic value of n's disease and malignant lymphoma is not high and difficult to identify. Because the pathological examination can only be limited by biopsy of the mucosa from the mucosa, it is impossible to observe the whole appearance of the whole intestinal wall and the lesion, and it is not easy to find some characteristic lesions. Therefore, the typical morphological characteristics of ulcerative disease in the ileocecal region are not good. In the same way, a biopsy can not be completely confirmed, which leads to a missed diagnosis and misdiagnosis of the disease. Therefore, in general, we need to combine the features of the endoscopic biopsy with a comprehensive analysis to improve the diagnostic rate of the ileocecal lesion.

【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574

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