结肠镜检查在慢性腹泻患者中的诊断价值  

The diagnostic value of colonoscopy for chronic diarrhea

作　　者：顾红祥[1] 智发朝[1] 黄颖[1] 周丹[1] 张亚历[1] 

机构地区：[1]南方医科大学南方医院消化科,广州510515

出　　处：《中华消化内镜杂志》2013年第5期261-264,共4页Chinese Journal of Digestive Endoscopy

摘　　要：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（x^2=2．756，P=0．097）。慢性腹泻组的非炎症性肠病一非感染性肠炎、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一非感染性肠炎、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。Objective To evaluate the diagnostic value of colonoscopy for patients with chronic di- arrhea. 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 endoscop- ic findings and negative finding were compared between two groups. Results Lesions with clinic signifi- cance 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 co- litis （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 = O. 039 ） were all significantly higher in patients with chronic diarrhea. However, inci- dences of adenomatous polyps （X2 = 14. 124, P 〈 0. 001 ） , non-adenomatous polyps 0（2 = 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 = O. 202 ） and an- giodysplasia （X2 = 0. 231, P = 0. 631 ） between the two groups. The overall screening rate of colonic polyps, divertieulosis, and vascular lesions was 37.3% in chronic diarrhea group. Conclusion Colonic polyps, di- verticulitis, 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 eolonoscopy.

关 键 词：慢性腹泻 结肠镜 器质性病变 

分 类 号：R57[医药卫生—消化系统]