结肠镜及组织学检查对儿童克罗恩病的诊断价值

Colonoscopy and biopsy in the diagnosis of pediatric Crohn's disease

目的探讨结肠镜诊断儿童克罗恩病的重要性及活检组织学检查的价值。方法回顾性分析近10年诊治的10例克罗恩病患儿结肠镜下特点及活检组织学特点,分析其诊断价值。结果10例克罗恩病患儿中,小肠结肠型6例,结肠型1例,小肠型3例。累及结肠7例中结肠镜下全结肠累及者2例(28.5%),左半结肠、右半结肠或横结肠累及者各3例(42.9%),乙状结肠、回盲部累及者各2例(28.5%),直肠累及者1例(14.3%)。结肠镜下表现有节段性分布、溃疡多样性、修复性改变、部分肠管狭窄僵硬等特点。活检组织学以淋巴细胞浸润多见,肉芽肿检出率28.5%。结论结肠镜检查在克罗恩病诊断中有重要意义,常规结肠镜下活组织学检查缺乏特异性,可多部位、深凿活检以提高阳性率。

Objectives To evaluate the importance of endoscopy and histological features in establishing a diagnosis of pediatric Crohn＇s disease. Methods Data of endoscopic findings and biopsy on Crohn＇s disease from a 10- year medical record were retrospectively reviewed, Results Of 10 children diagnosed as Crohn＇s disease, 7 were colon involved. However, involvement limited to the colon alone was seen in only 1 cases. Discontinuous lesions, diverse ulcer, proliferative/regenerative patterns and narrowed bowel lumen were observed under endoscopy. Histologically, lymphoeytes aggregation in the lamina propria and submucosa were found. Non-caseating granulomas were detected in 28.5% cases. Conclusions Colonoscopy is valuable in establishing the diagnosis of pediatric Crohn＇s disease. Colono- scopic biopsies were short of specificity. Multi-site and deep biopsy are needed to improve the positive rate.