血吸虫肠病误诊分析65例

Misdiagnosis of intestinal schistosomiasis:An analysis of 65 cases

目的:分析血吸虫肠病的内镜表现及病理学特征,探讨内镜误诊的原因以降低其误诊率.方法:回顾性分析我院消化内镜中心2000-01/2012-12经病理确诊为血吸虫肠病、但结肠镜检查误诊的65例患者的病史、结肠镜下表现以及组织病理学检查结果等临床资料,分析结肠镜检查误诊的原因.结果:65例患者临床资料及内镜检查均未提示血吸虫肠病,误诊为溃疡性结肠炎19例,肠结核4例,Crohn病2例,结肠息肉23例,结肠癌17例.误诊为结肠息肉和结肠癌的40例患者中合并高级别上皮内瘤变2例,低级别上皮内瘤变1例,管状腺瘤2例,绒毛状腺瘤1例,管状绒毛状腺瘤1例.结论:结肠镜检查前详细询问病史,术中对可疑病变行多部位多个位点活检是提高血吸虫肠病诊断准确率的重要手段.

AIM： To analyze the endoscopic and pathologi- cal characteristics of intestinal schistosomiasis and to explore the reasons for its misdiagnosis. METHODS： The medical history, endoscopic findings and pathologic characteristics of 65 patients with intestinal schistosomiasis who un- derwent colonoscopy from January 2000 to De- cember 2012 at our hospital were retrospectively analyzed. RESULTS： Intestinal schistosomiasis was not initially suggested by clinical and endoscopi- cal diagnosis in all the 65 patients. Of all themisdiagnosed patients, 19 were misdiagnosed with ulcerative colitis, 4 with intestinal tuber- culosis, 2 with Crohn＇s disease, 23 with colonic polyps, and 17 with colonic carcinoma. Of the 40 patients misdiagnosed with colonic polyps or carcinoma, 2 had high-grade intraepithelial neoplasia, 1 had low-grade intraepithelial neo- plasia, 2 had canalicular adenoma, 1 had villous adenoma, and I had tubulovillous adenoma. CONCLUSION： A thorough inquiry of medical history combined with colonoscopy biopsy of suspected lesions is important for improving the diagnostic accuracy of intestinal schistosomiasis.