CAJ | 학술논문

目的分析慢性腹泻患者结肠镜下特点,从内镜表现上寻找慢性腹泻的可能病因,评价结肠镜检查在慢性腹泻患者中的价值.方法回顾近年来2449例慢性腹泻患者的内镜结果,作为慢性腹泻组,以同时期行结肠镜检查的2110例健康体检者作为对照组,分析慢性腹泻患者内镜阴性比例、最常见的内镜下异常、有临床意义的内镜异常.结果慢性腹泻组和对照组结肠镜下器质性病变比例分别为44.1％和41.7％,2组比较差异无统计学意义(x2=2.756,P=0.097).慢性腹泻组的非炎症性肠病-非感染性肠炎、炎症性肠病、恶性肿瘤、回肠末段炎、感染性肠炎、肠结核、寄生虫检出率均明显高于对照组(P＜0.05);对照组的结肠息肉(腺瘤性息肉和非腺瘤性息肉)、憩室检出率均明显高于慢性腹泻组(P＜0.05).良性肿瘤、血管性病变检出率2组无差异.慢性腹泻组中非炎症性肠病-非感染性肠炎、结肠息肉、憩室、良性肿瘤、血管性病变总检出率为37.3％ (913/2449).结论结肠息肉、憩室、良性肿瘤、血管性病变可能不是慢性腹泻的病因;结肠镜检查对超过1/3慢性腹泻患者不能明确病因.
목적 분석만성복사환자결장경하특점,종내경표현상심조만성복사적가능병인,평개결장경검사재만성복사환자중적개치.방법 회고근년래2449례만성복사환자적내경결과,작위만성복사조,이동시기행결장경검사적2110례건강체검자작위대조조,분석만성복사환자내경음성비례、최상견적내경하이상、유림상의의적내경이상.결과 만성복사조화대조조결장경하기질성병변비례분별위44.1％화41.7％,2조비교차이무통계학의의(x2=2.756,P=0.097).만성복사조적비염증성장병-비감염성장염、염증성장병、악성종류、회장말단염、감염성장염、장결핵、기생충검출솔균명현고우대조조(P＜0.05);대조조적결장식육(선류성식육화비선류성식육)、게실검출솔균명현고우만성복사조(P＜0.05).량성종류、혈관성병변검출솔2조무차이.만성복사조중비염증성장병-비감염성장염、결장식육、게실、량성종류、혈관성병변총검출솔위37.3％ (913/2449).결론 결장식육、게실、량성종류、혈관성병변가능불시만성복사적병인;결장경검사대초과1/3만성복사환자불능명학병인.
Objective To evaluate the diagnostic value of colonoscopy for patients with chronic diarrhea.Methods Data of 2449 patients with chronic diarrhea who underwent colonoscopy from January,1999 to December,2008 were reviewed.A total of 2110 patients who underwent colonoscopy screening for health checkup during the same period were used as controls.The rates of clinic-relevant abnormal endoscopic findings and negative finding were compared between two groups.Results Lesions with clinic significance were found in 44.1％ of patients with chronic diarrhea (1080/2449) and in 41.7％ of controls (870/2110,x2 =2.756,P =0.097).Compared with controls,incidence of non-IBD and noninfectious colitis (x2 =58.578,P ＜ 0.001),IBD (x2 =59.609,P ＜ 0.001),malignant tumor (x2 =21.649,P ＜0.001),terminal ileitis (x2 =6.275,P =0.012),infectious colitis (x2 =17.019,P ＜0.001),intestinal tuberculosis (x2 =7.021,P =0.008),melanosis coli (x2 =6.040,P =0.014) and parasitic infection (x2 =4.245,P =0.039) were all significantly higher in patients with chronic diarrhea.However,incidences of adenomatous polyps (x2 =14.124,P ＜ 0.001),non-adenomatous polyps (x2 =33.427,P ＜0.001) and diverticular disease (x2 =9.921,P =0.002) were significantly higher in the control group.There was no significant difference in incidences of the benign tumor (x2 =1.627,P =0.202) and angiodysplasia (x2 =0.231,P =0.631) between the two groups.The overall screening rate of colonic polyps,diverticulosis,and vascular lesions was 37.3％ in chronic diarrhea group.Conclusion Colonic polyps,diverticulitis,benign tumors and angiodysplasia may not be the causes of chronic diarrhea.Etiology of more than 1/3 patients with chronic diarrhea remains unknown after colonoscopy.