26例孤立性直肠溃疡综合征临床分析  

Clinical analysis of 26 cases with solitary rectal ulcer syndrome

作　　者：李俊蓉 凌方梅 陈翌东 郑丽端[2] 朱良如[1] Li Junrong;Ling Fangmei;Chen Yidong;Zheng Liduan;Zhu Liangru(Department of Gastroenterology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Pathology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院消化内科,武汉430022 [2]华中科技大学同济医学院附属协和医院病理科,武汉430022

出　　处：《中华炎性肠病杂志（中英文）》2021年第1期68-72,共5页Chinese Journal of Inflammatory Bowel Diseases

摘　　要：目的分析孤立性直肠溃疡综合征(SRUS)的临床特点。方法回顾性分析华中科技大学同济医学院附属协和医院2015年6月至2019年11月收治的26例确诊为SRUS的患者临床资料。采用描述性方法统计患者的一般资料、临床表现、内镜、病理检查、治疗和转归等情况。结果26例患者,男11例,女15例,年龄(41.96±13.83)岁,诊断时的中位病程(范围)21(0.2~480)个月。临床表现为血便15例(57.69%)、直肠脱垂9例(34.62%)、肛周疼痛6例(23.08%)、体质量下降6例(23.08%)、黏液便5例(19.23%)。17例患者行普通肠镜检查,内镜表现为溃疡6例(35.29%)、息肉5例(29.41%)、隆起样改变4例(23.53%)、增生肿胀4例(23.53%)、糜烂3例(17.65%),单独或联合出现。病理表现包括黏膜表面糜烂溃疡11例(42.31%)、固有层纤维化8例(30.77%)、黏膜腺体缺失或分泌减少6例(23.08%)、炎性细胞浸润5例(19.23%)、血管异常5例(19.23%)、隐窝改变4例(15.38%)。5例(19.23%)患者接受内科治疗,21例(80.77%)患者接受外科治疗。随访9~62(29.50±9.27)个月,除直肠脱垂外,患者其余症状均消失或好转。结论SRUS患者临床及内镜表现多变,临床上易误诊。病理对诊断及鉴别诊断十分重要。内外科治疗方案对SRUS均有效。Objective To analyze the clinical characteristics of solitary rectal ulcer syndrome(SRUS).Methods Retrospective analysis was performed on the data of 26 patients with SRUS diagnosed by pathology and admitted to Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2015 to November 2019.A descriptive method was used to collect the general information,clinical manifestations,endoscopy,pathological examination,treatment and prognosis of patients.Results A total of 26 patients were enrolled,including 11 males and 15 females,with average age of(41.96±13.83)years old and median duration of 21(0.2-480)months from onset to diagnosis.The main clinical manifestations were rectal bleeding in 15(57.69%)cases,rectal prolapse in 9(34.62%),perianal pain in 6(23.08%),body mass loss in 6(23.08%)and rectal mucus in 5(19.23%).Seventeen patients underwent endoscopic examination,endoscopic features included ulcer in 6(35.29%)cases,rectal polyp in 5(29.41%),protuberance in 4(23.53%),hyperplasia and swelling in 4(23.53%),erosion in 3(17.65%),either alone or in combination.Histological examination of rectal biopsies revealed that the characteristic features were mucosal surface erosion and ulcer in 11(42.31%)cases,lamina propria fibrosis in 8(30.77%),mucosal gland deletion or decreased secretion in 6(23.08%),inflammatory cell infiltration in 5(19.23%),vascular changes in 5(19.23%),and crypts alteration in 4(15.38%).Five patients(19.23%)received medical treatment and 21 patients(80.77%)received surgery.Symptoms except rectal prolapse disappeared or were improved in all the patients after treatment.Conclusion The clinical and endoscopic features of SRUS are variable.Pathology is crucial for diagnosis and differential diagnosis.Both the medical and surgical treatment are effective for SRUS.

关 键 词：孤立性直肠溃疡综合征 直肠脱垂 内镜 病理 

分 类 号：R574.63[医药卫生—消化系统]