淋病双球菌性直肠结肠炎的诊断

Colonoscopic diagnosis of gonorrheal proctocolitis

目的总结淋病双球菌性直肠、结肠炎的临床、内镜特征,以提示消化科医师对此疾病的注意。方法回顾经内镜诊断的6例淋病双球菌性直肠、结肠炎患者资料,归纳分析其临床、内镜下表现及病理学、细菌学检查结果。结果淋病双球菌性直肠、结肠炎患者多以肛门搔痒、烧灼感及腹泻为主诉。肠镜下直肠及乙状结肠粘膜均有不同程度水肿、充血,表面附有较多粘液,3例附有脓性分泌物,2例有散在片状出血点及局灶性糜烂及浅表溃疡。病理学检查4例呈慢性炎症改变,2例呈灶性糜烂、坏死,形成浅表溃疡。分泌物涂片革兰氏染色4例阳性,6例均培养出淋病双球菌。结论淋病双球菌性直肠、结肠炎内镜下无特异性改变,但严重者可见有较多脓性分泌物,分泌物涂片革兰氏染色有诊断价值,培养阳性率最高。

Objective To study the endoscopic manifestation of gonorrheal proctocolitis.Methods Retrospectively reviewed and analysed the clinical and endoscopic smaples of 6 gonorrheal proctocolitis cases on the findings of clinical endoscopic features,pathology,mucus smear and cultures.Results Colonoscopic features of rectum and distal sigmoid mucosa revealed varying grades of edema,congestion and abundant mucus in 6 cases;supurative secretion in 3 cases;scattered bleeding spots,local erosive and superficial ulceration in 2 cases. Pathological findings were chronic inflammation in 4 cases,local erosion,necrosis with superficial ulceration in 2 cases.Rectum mucus smear and mucus culture were positive for gonococcus in all 6 cases.Conclusion The colonoscopic and pathological features of proctocolitis merely showed the non-specific changes even in the severe cases.The gram stain and culture of rectal mucus,particularly the later,gave the highest diagnostic significance.