小肠克罗恩病临床特征及诊疗分析  

Analysis of clinical characteristics and diagnosis of small bowel Crohn's disease

作　　者：郑秀金[1] 陈长旦[1] 毛文灏[1] 

机构地区：[1]福建医科大学附属宁德市医院消化内科,福建宁德352100

出　　处：《中国医药科学》2014年第22期43-45,共3页China Medicine And Pharmacy

摘　　要：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。Objective To investigate the clinical features and treatment of small bowel Crohn＇s disease,improve the level of diagnosis and treatment of this disease. Methods 45 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. Results Clinical 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. Conclusion The 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.

关 键 词：小肠 克罗恩病 临床特征 诊疗 回顾性分析 

分 类 号：R574[医药卫生—消化系统]