肠巨大溃疡的病因和临床分析

The etiology and clinical analysis of giant intestinal ulcer

目的探讨肠巨大溃疡的病因、临床特征及诊断方法,为肠巨大溃疡的临床诊断提供参考依据。方法回顾性分析武汉大学人民医院245例肠巨大溃疡患者的病因、临床特点、内镜检查、病理学检查及诊断方法。结果肠道巨大溃疡以溃疡型肠癌、克罗恩病、肠结核、淋巴瘤、孤立性溃疡及缺血性肠炎常见,感染性肠炎、腹型过敏性紫癜、肠道白塞病及结肠嗜酸性肉芽肿等少见病因也不容忽视。不同诊断方法以内镜结合病理的诊断敏感性最高达60.4%。肠道巨大溃疡主要表现为腹痛、血便、发热、贫血或体重下降,一些病因具有特异的肠外表现,具有重要的诊断意义,如克罗恩病常合并肛周病变、口腔和外生殖器溃疡及内瘘等。血常规、血沉及CRP等血液学检查的意义不大。内镜检查初步可区分良恶性溃疡,溃疡多见于直肠和回盲部,多为单发,多发以感染性溃疡最多见达71.4%(5/7)。91.6%孤立性溃疡病检见成纤维细胞浸润、77.8%溃疡型肠癌病检见恶性细胞等特殊的病理结果支持内镜及临床拟诊,提高确诊率。结论肠道巨大溃疡病因复杂,较难鉴别,详尽的问诊和体检、全面的实验室检查、高质量的内镜检查、多次多部位挖掘式病理学检查具有重要的诊断价值。

【Obsjective】To study the etiology, clinical characteristics and diagnostic methods of intestinal giant ulcer, provide reference for its clinical diagnosis. 【Method】The etiology, clinical characteristics, endoscopic and histological examination and diagnosis method of 245 patients of intestinal giant ulcer in Wuhan University hospital were retrospectively analyzed. 【Results】 The common reasons of intestinal giant ulcer in turn were ulcerative carcinoma, crohn disease, intestinal tuberculosis, lymphoma, solitary ulcers, ischemic colitis. Other rare etiology of infectious enteritis, abdominal allergic purpura, intestinal Behcet＇s disease, colon eosinophilil granuloma was also not to be ignored. Endoscopy combined with pathological diagnosis was the most sensitive for the all different diagnostic methods, which was up to 60.4%. The main clinical manifestation was abdominal pain, bloody stool, fever, anemia, weight loss, some etiology with specific extraintestinal manifestations, such as Crohn disease often complicated with perianal lesions, oral and genital ulcers, fistula and so on, which had important significance in the diagnosis. But the blood examination of hemogram, ESR, CRP was of little significance. Endoscopy could preliminarily differentiate benign from malignant ulcer, mostly singly occurred in rectum and ileocecal ,but infectious ulcers were mostly multiple which accounted for 71.4% （5/7）. Special pathological findings, such as fibroblast infiltration of 91.6% solitary ulcer, malignant cells of 77.8% ulcerative carcinoma, supported the endoscopic and clinical suspected diagnose and improved the diagnosis rate.【Conclusion】Intestinal giant ulcer etiology was complex and difficult to identify, exhaustive interrogation and physical examination, comprehensive laboratory examination, high quality of endoscopic examination, multiple and mining type biopsy are important for diagnosis.