结肠镜下单纯性直肠溃疡的临床特征分析  

Clinical features of simple rectal ulcer discovered by colonoscopy

作　　者：赵狄 刘艳迪[1] ZHAO Di;LIU Yandi(Department of Gastroenterology,Tianjin People's Hospital,Tianjin(300122),China)

机构地区：[1]天津市人民医院消化内科,天津300122

出　　处：《中国中西医结合外科杂志》2022年第6期869-872,共4页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:分析结肠镜发现的单纯性直肠溃疡的临床特征及病理特点。方法:回顾性分析2016年9月—2022年3月在天津市人民医院消化内科进行结肠镜检查的37489例患者的临床资料。入选标准:直肠溃疡,直径≥0.2 cm,单发或多发,无结肠炎及结肠溃疡等其他结直肠疾病。入选患者44例,占同期行结肠镜检查者的1.17‰(44/37489)。其中男性21例,女性23例,年龄16~81岁,平均(53.0±14.8)岁。结果:44例单纯性直肠溃疡的症状包括便血、腹痛、排便不尽感、下腹/肛门坠胀、腹泻、腹胀及排便次数增多等,还有个别患者出现排便费力、里急后重及发热等表现。其中以腹痛及便血最为常见,占比达40%以上。内镜表现:溃疡直径0.2~1.0 cm者24例,1.1~3.0 cm者13例,>3.0 cm者7例。单发溃疡25例(56.8%),多发溃疡12例(27.3%),占据管腔1/4及以上大溃疡7例(15.9%)。病因学分析:非特异性直肠炎29例,溃疡性直肠炎5例,缺血性直肠炎4例,肠克罗恩病、肠阿米巴病各1例,还有4例未明确病因,其中病理可见异型细胞3例,疑似血管炎相关疾病1例。结论:非特异性直肠炎在单纯性直肠溃疡中所占比例较高。内镜联合活检对于明确单纯性直肠溃疡的病因具有重要意义。Objective To investigate the clinical and pathological features of the simple rectal ulcer proven by colonoscopy.Methods The clinical data of 44 patients,accounted for 1.17‰(44/37489)of the patients who underwent colonoscopy during the same period,21 males and 23 females,aged(16-81)(53.0±14.8)with simple rectal ulcers value,≥2 mm in diameter,excepting colitis,colonic ulcer and other colorectal diseases were analyzed in Tianjin People's Hospital from September 2016 to March 2022.Results The clinical manifestations included hematochezia,abdominal pain,sensation of incomplete defecation,lower abdominal/perianal distension,diarrhea,abdominal distension and increased stool frequency.Less frequent symptoms include defecatory straining,tenesmus and fever.Abdominal pain and hematochezia were the most common symptoms accounted for more than 40%.24 patients had the ulcers 0.2~1.0 cm in diameter,13 patients with the size of 1.1~3.0 cm and 7 patients were larger than 3.0 cm.Single ulcer was seen in 25 patients(56.8%)and multiple in 12(27.3%),there were 7 patients(15.9%)with the ulcers more than a quarter of the intestinal canal.Mostly,29 cases were diagnosed as non-specific proctitis.The other diagnoses were ulcerative proctitis(5 cases),ischemic proctitis(4 cases),Crohn's disease(1 case)and amebic colitis(1 case).In addition,there were 4 cases with unknown etiology,including 3 cases with pathological atypia,and 1 case with vasculitisrelated diseases.Conclusion Non-specific proctitis is a high proportion in the spectrum of simple rectal ulcer.Colonoscopy plus biopsy play an important role in the etiological diagnosis of simple rectal ulcer.

关 键 词：直肠溃疡 结肠镜检查 病因学 

分 类 号：R574.63[医药卫生—消化系统]