600例小肠溃疡患者的临床特点分析  

Clinical characteristics analysis of 600 cases of small intestinal ulcer

作　　者：刘媛 吴蓉 蔡龙娇 冷爱民[1] LIU Yuan;WU Rong;CAI Longjiao;LENG Aimin(Department of Gastroenterology,Xiangya Hospital of Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院消化内科,湖南长沙410008

出　　处：《胃肠病学和肝病学杂志》2023年第2期135-141,共7页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的 总结不同类型小肠溃疡的临床表现、实验室检查、影像学及预后特征。方法 纳入中南大学湘雅医院双腔气囊小肠镜(double balloon enteroscopy, DBE)或胶囊内镜(capsule enterscopy, CE)发现小肠溃疡的患者,回顾性分析其临床资料并随访预后。结果 600例小肠溃疡主要以男性的克罗恩病患者多见。临床症状主要表现为腹痛、腹泻、体质量下降。实验室检查可有白细胞升高、贫血和低蛋白血症。影像学检查中,CT主要表现依次是:肠壁节段性不均匀增厚、淋巴结肿大、管腔狭窄或梗阻,其病变检出率为95.6%。DBE下溃疡特点主要表现为多个不规则或纵行溃疡,黏膜有不同程度的充血水肿及狭窄,500例(83.3%)患者的溃疡位于回肠。结肠镜联合CT检出率达97.8%。病理改变主要是慢性炎和炎细胞浸润。103例(17.2%)患者预后不佳,血红蛋白、血沉和C反应蛋白与预后有统计学意义(P<0.5)。结论 小肠溃疡临床表现无特异性。结肠镜联合CT检查对于发现病变有一定意义。大部分患者在对其病因予以相应治疗后预后较好,但对于有贫血、血沉增快、C反应蛋白升高的小肠溃疡患者需要密切随访。Objective To summarize the clinical manifestations, laboratory tests, imaging and prognostic features of different types of small intestinal ulcers. Methods Included in Xiangya Hospital of Central South University, double balloon enteroscopy(DBE) and capsule enterscopy(CE) found that patients with small intestinal ulcers, retrospectively analyzing the clinical data and making follow-up prognosis. Results 600 cases of small ulcers were predominantly seen in men with Crohn′s disease. The main symptoms were abdominal pain, diarrhea, and weight loss. Laboratory tests may include elevated leukocytes, anemia and hypoproteinemia. In the imaging examination, CT mainly showed segmental uneven thickening of the intestinal wall, lymph node enlargement, luminal stenosis or obstruction, and its lesion detection rate was 95.64%. Ulcers under DBE were mainly characterized by multiple irregular or longitudinal ulcers with varying degrees of mucosal congestion and edema and stenosis, and the ulcers in 500 patients(83.3%) were located in the ileum. The detection rate of gastroenteroscopy combined with CT was 97.83%. Pathological changes were mainly chronic inflammation and inflammatory cell infiltration. 103 patients(17.2%) had a poor prognosis, and hemoglobin, erythrocyte sedimentation rate and C-reactive protein were statistically associated with prognosis(P<0.05). Conclusion The clinical presentation of small intestinal ulcers is not specific. Colonoscopy combined with CT examination has some significance in detecting lesions. Most patients have a good prognosis after appropriate treatment of their etiology, but patients with small intestinal ulcers with anemia, increased erythrocyte sedimentation rate, and elevated C-reactive protein need to be followed closely.

关 键 词：小肠溃疡 病因诊断 检查 预后 

分 类 号：R574[医药卫生—消化系统]