克罗恩病与原发性肠道淋巴瘤临床表现的异同

The clinical differences and similarities between Crohn's disease and primary intestinal lymphoma

目的对克罗恩病(CD)与原发肠道淋巴瘤(PIL)进行临床比较,找出对鉴别诊断有帮助的要点。方法回顾性分析我院1983年1月-2004年7月间CD 90例和PIL 46例住院患者,所有数据采用X2检验、t检验或非参数秩和检验。结果 PIL患者平均年龄高于CD患者近10岁[(45．0±16．2)岁比(36．7±15．7)岁,P<0．01],而PIL患者的病程中位数明显短于CD患者(4．0个月比36．0个月, P<0．01)。肛周病变在CD患者中多见(P<0．01)。肠梗阻及瘘管形成在CD患者更常见(P< 0．05)。60．9％PIL患者为单部位受累,明显高于CD患者(P<0．05)。腹部包块、腹腔淋巴结肿大和腹腔积液在PIL患者中多见(P<0．05),共有69例CD及20例PIL患者行消化道造影,显示PIL中充盈缺损、管壁僵硬、肠套叠多于CD(P<0．05)。共有67例CD及18例PIL患者接受内镜检查,活检确诊PIL占61．1％,而82．1％CD提示为非特异性炎性改变。CD和PIL的术前确诊率分别为17．7％和25．0％。结论 CD与PIL的诊断与鉴别诊断难度高,年轻而病程长、有肛周病变、瘘管形成、多部位病变者更支持CD,病情易复发;PIL病程短,单部位病变,内镜活检率确诊较高。

Objective To identify the main clinical characteristics helpful for diagnosis and differential diagnosis of Crohn＇s disease （CD） from primary intestinal lymphoma （PIL）. Methods Ninety cases of CD and 46 cases of PIL during 1983-2004 in Peking Union Medical College Hospital were investigated retrospectively. Results The average age of PIL was nearly 10 years elder than that of CD （45.0±16.2 vs. 36.7±15.7, P〈0. 01）. The median course of CD was significantly longer than that of PIL（36.0 vs. 4.0 months, P〈 0.01）. Perianal involvement was more common in CD than that in PIL（P〈0.01）. Obstruction and fistulization of alimentry tract were more common in CD （P〈0.05）. Abdominal mass, involvement of celiac lymph node and ascites were more common in PIL than that in CD （P〈0.05）. Gastrointestinal tract harium studies were carried out in 69 CD and 20 PIL. The signs of filling defect, rigidity of mucosal folds and intussusception were more common in PIL （P〈0. 05）. Endoscopy was carried out in 67 CD and 18 PIL, based on the results of biopsies, the diagnosis was established in 61.1% of PIL, but 82. 1% of CD showed nonspecific inflammatory changes. The correct diagnosis ratio in preoperation was 17. 7% of CD and 25.0% of PIL. Conclusions It is difficult in differential diagnosis between CD and PIL. CD tends to be younger, to have longer course and more perianal complications. The biopsy under endoscopy is important in the diagnosis of PIL.