回盲部病变55例诊治分析

Analysis of 55 patients with ileocecal lesions

目的分析回盲部病变的病因及临床特征,提高对回盲部病变认识及诊治水平。方法收集我院自2005年5月至2014年3月有完整资料的回盲部疾病的手术病例,统计入院后的B超、CT、X线钡剂灌肠造影及结肠镜等检查结果及术前诊断和术后病理诊断。结果资料完整的回盲部病变患者55例,临床表现为腹痛、腹胀48例,以右下腹及脐周为主,右下腹扪及包块16例,便血或脓血便9例,腰痛2例,腹泻4例,肠梗阻7例,肠套叠2例,肠穿孔2例。术前初诊胆囊结石1例,8例术前初诊急性阑尾炎,术中探查发现回盲部包块(其中回盲部癌2例,回盲部间质瘤1例,回盲部憩室伴脓肿1例,回盲部炎性肿块4例),阑尾炎手术后3例(回盲部癌1例,回盲部炎性肿块1例,回盲部肠管皮肤瘘1例)。结肠镜检查与B超、CT及X线钡剂灌肠造影等检查相比,对提高术前诊断价值更大。结论详细询问病史与体格检查,配合结肠镜等辅助检查综合判断,可以有效提高临床对回盲部病变的诊断水平。

Objective To analyze the etiology and clinical data of ileocecal lesions to improve the level of the diagnosis and treat -ment.Methods Clinical data of all patients with ileocecal lesions were analyzed in our department from May 2005 to April 2014.All cases had received the routine inspection ,B-ultrasound examination ,CT,barium enema radiography and colonoscopy ,and were confirmed by histopa-thology after the operation.Results The clinical symptoms of all patients included abdominal pain or distension (48 cases),right lower ab-dominal mass (16 cases),hematochezia and blood purulent stool (9 cases),low back pain (2 cases),diarrhea (4 cases),intestinal obstruc-tion (7 cases),intussusception (2 cases) and intestinal perforation (2 cases).In all patients,one case was misdiagnosed as cholecystolithia-sis before operation;eight cases were misdiagnosed as acute appendicitis but were found in the operation that there was ileocecal mass inclu -ding malignancies in ileocecal region ,stromal tumor,diverticulitis and inflammatory mass .Three cases with the history of appendectomy were diagnosed as malignancies in ileocecal region ,inflammatory mass and enterocutaneous fistula respectively .Colonoscopy was a better method to improve the correct rate of the diagnosis of ileocecal lesions than B-ultrasound examination ,CT and barium enema radiography .Conclusion Detailed disease history and attentive physical examination combined with colonoscopy ,B-ultrasound,CT,barium enema radiography can effec-tively improve the understanding and clinical diagnosis of ileocecal lesions .