结肠镜活检标本在克隆病诊断中的价值

DIAGNOSTIC SIGNIFICANCE OF ENDOSCOPIC BIOPSY IN CROHN’S DISEASE

目的 :探讨内镜活检对克隆病 (Crohn’sDisease ,CD)的诊断价值及CD的病理特点。方法 :对病理证实的35例CD的手术及活检标本进行回顾性分析。结果 :CD典型大体 (内镜 )改变如铺路石样改变、纵形裂隙状溃疡等并不常见 ;活检标本不能反映CD病理改变的全貌 ,肉芽肿检出率仅为 34 .4% (12 / 35 ) ,其中 6 0 % (9/ 12 )是 2块及 2块以上活检组织中仅有一块组织能发现肉芽肿。手术标本肉芽肿的检出率不超过 6 2 .8%(2 2 / 35 ) ;在手术证实的 35例CD中 ,活检诊断只有 10例 (2 8.8% )。结论 :活检诊断CD的价值有限 ,但多块、深凿活检可提高诊断正确率 ;CD的病理改变仅具有相对特异性 ,肉芽肿改变不是诊断CD的充要条件 ,CD的诊断是临床、X线、内镜及病理检查的综合性诊断。

Objective:To investigate the diagnostic value of endoscopic biopsy in Crohn's disease (CD) and the pathological features of CD.Methods:Resected specimens and biopsies from 35 patients who eventually had CD proven by pathology were retrospectively analysed.Results:①The typical macroscopic pattern of cobble appearance and long linear ulcer were uncommon;②Biopsy tissues were too small to reflect all of pathological features of CD.Epithelioid granulomas present in 34.4% (12/35) of biopsies from patients with CD,60% (9/12) of these granulomas were found in one of two or more biopsies,but 62.8%(22/35) of resected specimens would demonstrate them.③Biopsy diagnostic accuracy for CD was 28.8%(10/35) comparing with the operative results.Conclusions:①Biopsy is of limited diagnostic value in CD,but multiple biopsies,and deeper biopsies can increase diagnostic accuracy.②The pathological features of CD have only relative specificity for diagnosis.Epithelioid granulomas is not essential to comfirm the diagnosis of CD,The latter is a symptom of clinical,radiologic,endoscopic and pathological findings.