内镜及病理学检查在克罗恩病和肠结核鉴别诊断中的价值  

Clinical value of endoscopy and histopathology in differential diagnosis of intestinal tuberculosis and Crohn's disease

作　　者：缪应雷[1] 欧阳钦[1] 陈岱云[2] 普苹[3] 

机构地区：[1]华西医科大学附属一医院消化科,成都610041 [2]华西医科大学附属一医院病理科 [3]昆明医学院第一附属医院

出　　处：《中华消化内镜杂志》2002年第1期9-12,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价内镜及组织病理学检查在克罗恩病和肠结核的鉴别诊断中的价值。方法回顾性复习经手术证实的克罗恩病和肠结核各30例资料,对其临床、内镜表现、手术记录等进行分析,并重新审读病理切片。结果内镜诊断克罗恩病的灵敏度、特异度和准确性分别为80.0%、25.6%和49.3%,而在肠结核中的灵敏度、特异度和准确性分别为86.7%、46.2%和63.8%。克罗恩病的病理学特征有非干酪样肉芽肿、粘膜下层增宽、裂隙样溃疡和淋巴细胞聚集;肠结核的病理特征有肠壁或肠淋巴结干酪样坏死、粘膜下层变窄或闭缩。结论尽管找到了克罗恩病和肠结核的临床、内镜和组织病理学特征,但手术标本的组织病理学在鉴别诊断中仍起决定作用。Objective Clinical values of endoscopy and histopathology in differential diagnosis of Crohn's disease(CD) and intestinal tuberculosis were evaluated by characterising the distinctive diagnostic features of CD and intestinal tuberculosis in surgically resected specimens.Methods To review retrospectively the surgical enterocolonic specimens and to compare the clinical,endoscopic and morphologic features of CD or intestinal tuberculosis.Selected histological parameters were evaluated retrospectively in both 30 cases of CD and intestinal tuberculosis.Results The sensitivity,specificity and accuracy of endoscopy in diagnosis of CD and intestinal tuberculosis were 80.0%,25.6% 49.3% and 86.7%,46.2% 63.8% respectively.The histological characteristic parameters of intestinal tuberculosis were confluent granulomas often with caseous necrosis and thinning submucosa;the features of CD were granulomas without caseous necrosis ,submucosal hyperplasia fissure like ulceration and prominent lymphoid aggregates.Some histopathology similarities of CD and intestinal tuberculosis were found,such as chronic non-specific inflammation of intestinal wall,ulceration,collections of epithelioid histocytes,microgranulomas and transmural inflammation.Conclusions Although distinctive diagnostic features of CD and intestinal tuberculosis were found in their clinical,endoscopical and pathological study.The final differential diagnosis depends largely upon pathology.

关 键 词：CROHN病 胃肠结核 内窥镜检查 病理学 鉴别诊断 

分 类 号：R574.62[医药卫生—消化系统]