中国医药科学
中國醫藥科學
중국의약과학
CHINA MEDICINE AND PHARMACY
2014年
22期
43-45
,共3页
小肠%克罗恩病%临床特征%诊疗%回顾性分析
小腸%剋囉恩病%臨床特徵%診療%迴顧性分析
소장%극라은병%림상특정%진료%회고성분석
Intestine%Crohn's disease%Clinical features%Diagnosis%Retrospective analysis
目的：探讨小肠克罗恩病的临床特征及诊疗，提高对本病的认识和诊疗水平。方法回顾性分析我院（部分病例首诊我院，后诊疗于北京、上海、福州等医院）2007年7月~2013年7月45例小肠克罗恩病的病例资料。结果小肠克罗恩病临床主要表现为腹痛（30例）、腹泻（18例）或（伴）便血（4例）。4例为术后病理发现（包括肠梗阻、腹膜炎、腹部包块手术）。2例以口腔溃疡、发热首发，2例为反复呕吐，2例以肛周脓肿首发。全身表现有贫血、低蛋白血症、发热、体重下降。病程最长达20年，最短1个月。病变多位于末端回肠，结肠常受累，尤以回盲部多见。最常见的并发症为肠梗阻（8例）。内镜下可见纵形溃疡、铺路石样改变、节段性、常伴有管状狭窄。病理表现为黏膜慢性炎伴急性活动，累及全层，部分可见裂隙状纵行溃疡及非干酪性肉芽肿。93.3%病例经过经典药物治疗症状改善，31.1%病例反复发作最终手术治疗。结论小肠克罗恩病临床表现复杂多样，缺乏特异性，诊断困难，需结合临床表现、影像学和消化内镜证据以及病理、追踪资料等综合判断，且病程长，病情反复，需进一步提高对小肠克罗恩病的认识。
目的：探討小腸剋囉恩病的臨床特徵及診療，提高對本病的認識和診療水平。方法迴顧性分析我院（部分病例首診我院，後診療于北京、上海、福州等醫院）2007年7月~2013年7月45例小腸剋囉恩病的病例資料。結果小腸剋囉恩病臨床主要錶現為腹痛（30例）、腹瀉（18例）或（伴）便血（4例）。4例為術後病理髮現（包括腸梗阻、腹膜炎、腹部包塊手術）。2例以口腔潰瘍、髮熱首髮，2例為反複嘔吐，2例以肛週膿腫首髮。全身錶現有貧血、低蛋白血癥、髮熱、體重下降。病程最長達20年，最短1箇月。病變多位于末耑迴腸，結腸常受纍，尤以迴盲部多見。最常見的併髮癥為腸梗阻（8例）。內鏡下可見縱形潰瘍、鋪路石樣改變、節段性、常伴有管狀狹窄。病理錶現為黏膜慢性炎伴急性活動，纍及全層，部分可見裂隙狀縱行潰瘍及非榦酪性肉芽腫。93.3%病例經過經典藥物治療癥狀改善，31.1%病例反複髮作最終手術治療。結論小腸剋囉恩病臨床錶現複雜多樣，缺乏特異性，診斷睏難，需結閤臨床錶現、影像學和消化內鏡證據以及病理、追蹤資料等綜閤判斷，且病程長，病情反複，需進一步提高對小腸剋囉恩病的認識。
목적：탐토소장극라은병적림상특정급진료，제고대본병적인식화진료수평。방법회고성분석아원（부분병례수진아원，후진료우북경、상해、복주등의원）2007년7월~2013년7월45례소장극라은병적병례자료。결과소장극라은병림상주요표현위복통（30례）、복사（18례）혹（반）편혈（4례）。4례위술후병리발현（포괄장경조、복막염、복부포괴수술）。2례이구강궤양、발열수발，2례위반복구토，2례이항주농종수발。전신표현유빈혈、저단백혈증、발열、체중하강。병정최장체20년，최단1개월。병변다위우말단회장，결장상수루，우이회맹부다견。최상견적병발증위장경조（8례）。내경하가견종형궤양、포로석양개변、절단성、상반유관상협착。병리표현위점막만성염반급성활동，루급전층，부분가견렬극상종행궤양급비간락성육아종。93.3%병례경과경전약물치료증상개선，31.1%병례반복발작최종수술치료。결론소장극라은병림상표현복잡다양，결핍특이성，진단곤난，수결합림상표현、영상학화소화내경증거이급병리、추종자료등종합판단，차병정장，병정반복，수진일보제고대소장극라은병적인식。
ObjectiveTo investigate the clinical features and treatment of small bowel Crohn's disease, improve the level of diagnosis and treatment of this disease.Methods45 cases of small bowel Crohn's disease admitted in our hospital(the first diagnosis in some cases in our hospital after diagnosis and treatment in Beijing, Shanghai, Fuzhou) form Jul 2007 to Jul 2013 were analyzed retrospectively.ResultsClinical small bowel Crohn's disease mainly for abdominal pain (30 cases), diarrhea (18 cases) or (and) hematochezia (4 cases). There were 4 cases of postoperative pathological findings (including intestinal obstruction, peritonitis, abdominal mass operation).2 patients with oral ulcers, fever onset, 2 cases of recurrent vomiting, 2 patients with perianal abscess in the first. Systemic manifestations with anemia, hypoproteinemia, fever, weight loss. The course of disease lasted 20 years, the shortest 1 months. The lesions were located in the terminal ileum, colon frequently involved, especially in the ileocecal. The most common complication of intestinal obstruction (8 cases). Endoscopic visible longitudinal ulcer, cobblestone like changes, segmental, often accompanied by tubular stricture. Pathological manifestations of mucosa of chronic inflammation with acute activities, involving the whole layer, partially visible slit shaped longitudinal ulcer and non caseating granuloma.93.3% cases of classic symptoms improved after drug treatment, 31.1% cases of recurrent final operation treatment. ConclusionThe clinical characteristics of small intestinal Crohn's disease are complex and diverse, the lack of specific, difficult diagnosis, based on clinical manifestations, imaging and endoscopic evidence and pathology, tracking the comprehensive judgment data, and the long duration of the disease, the illness relapses, further improve the understanding of small bowel Crohn's disease.
