以回盲部单发巨大溃疡为表现的克罗恩病的临床特点及文献复习  

Analysis of clinical features and literature review of Crohn′s disease presenting as a single giant ulcer in the ileocecal region

作　　者：陈雪娥[1,2,3] 林小燕 陈金通[1,2,3] 王承党[1,2,3] CHEN Xue′e;LIN Xiaoyan;CHEN Jintong;WANG Chengdang(Department of Gastroenterology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005;Department of Gastroenterology,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University;Fujian Provincial Clinical Research Center of Liver and Intestinal Diseases,China)

机构地区：[1]福建医科大学附属第一医院消化内科,福建福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心消化内科 [3]福建省肝病和肠道疾病临床医学研究中心

出　　处：《胃肠病学和肝病学杂志》2024年第6期659-665,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：福建省中青年教师教育科研项目(JAT200120);福建省自然科学基金重点项目(2021J02037)。

摘　　要：目的总结以回盲部单发巨大溃疡为表现的克罗恩病(Crohn’s disease,CD)的临床特点,为病变局限在回盲部的CD的临床诊疗和回盲部溃疡的病因鉴别提供参考。方法回顾性分析2013年7月至2021年12月福建医科大学附属第一医院收治的以回盲部单发巨大溃疡为表现的CD患者的临床特征及诊治过程,同时以“inflammatory bowel disease”、“Crohn′s disease”、“ileocecal ulcer”、“炎症性肠病”、“克罗恩病”、“回盲部溃疡”为检索词,检索PubMed、EmBase、中国知网、万方和维普等数据库1970年1月至2023年1月的文献,总结相关文献。结果我院6例患者均为男性,发病年龄(40.8±11.8)岁(29~59岁),从发现症状到确诊的中位时间为12.5个月。临床症状最主要是腹痛(6/6,100%)和体质量下降(6/6,100%),5例患者出现肠狭窄。CRP、ESR升高的比例均为66.7%(4/6),HGB、ALB降低的比例均为50.0%,2例T-SPOT阳性。结肠镜下回盲部溃疡以不规则形为主(3/6,50.0%),6例(100%)结肠镜组织活检病理均未见非干酪样肉芽肿。6例均接受手术治疗,1例术后病理见非干酪样肉芽肿。术后5例接受免疫抑制剂治疗,1例接受生物制剂治疗,随访时间为31~120个月,所有患者病情稳定,无激素临床缓解,无再次手术。文献系统检索结果显示,CD在回盲部溃疡性病变病因构成比占13.9%(297/2134),内镜确诊率为55.6%(90/162),组织活检确诊率为33.8%(49/145),内镜+组织活检确诊率为44.4%(67/151)。结论以回盲部单发巨大溃疡为表现的CD,首诊误诊率高,鉴别困难。内镜结合组织活检病理学对回盲部溃疡的病因确诊有重要意义,但存在一定的局限性,综合分析可提高诊断准确率。Objective To summarize the clinical characteristics of Crohn′s disease(CD)manifested by a single giant ulcer in the ileus,and to provide reference for the clinical diagnosis and treatment of CD with lesions confined to the ileus,and for the etiological differentiation of ileus ulcers.Methods We retrospectively analyzed the clinical characteristics,diagnosis and treatment process of CD patients with single giant ulcer in the ileocecal region admitted to the First Affiliated Hospital of Fujian Medical University from Jul.2013 to Dec.2021 and analyzed the clinical characteristics.“Inflammatory bowel disease”,“Crohn′s disease”,“ileocecal ulcer”were used as search terms,and the databases of PubMed,EmBase,CNKI,WanFang and VIP were searched from Jan.1970 to Jan.2023 to summarize the relevant literature.Results All 6 patients were male,with a mean age of onset of(40.8±11.8)years(29-59 years),and a median time from detection of symptoms to diagnosis of 12.5 months.Clinical symptoms were most predominantly abdominal pain(6/6,100%)and weight loss(6/6,100%),and intestinal stenosis was present in 5 patients.CRP and ESR were elevated in 66.7%(4/6),HGB and ALB were decreased in 50.0%,and 2 cases of T-SPOT were positive.Colonoscopic ileal ulcers were predominantly irregular in shape(3/6,50.0%),and the pathology of colonoscopic tissue biopsy did not show non-caseating granulomas in any of the 6 cases(100%).All 6 cases underwent surgical treatment,and non-caseating granulomas were seen on postoperative pathology in 1 case.Five cases received immunosuppressive therapy and 1 case received biologics after surgery.The follow-up period was 31-120 months.All patients were stable with no hormonal clinical remission and no reoperation.Literature systematic search showed that CD accounted for 13.9%(297/2134)of the etiologic composition of ulcerative lesions in the ileocecal region,with an endoscopic confirmation rate of 55.6%(90/162),a tissue biopsy confirmation rate of 33.8%(49/145),and an endoscopy+tissue biopsy confirma

关 键 词：回盲部溃疡 单发 克罗恩病 炎症性肠病 

分 类 号：R574.62[医药卫生—消化系统]