病变非连续性分布型溃疡性结肠炎的内镜分析

Colonoscopy analysis of inconsecutive distribution lesion of ulcerative colitis

目的总结溃疡性结肠炎患者内镜特点,并观察病变呈非连续性分布型患者所占比例。方法 96例溃疡性结肠炎患者,观察其内镜特点并进行分析。结果 96例患者中肠镜下表现为黏膜血管纹理改变者89例,黏膜充血水肿者78例,糜烂56例,溃疡45例,结肠袋变浅变钝消失16例,假息肉12例,黏膜桥4例。病变呈连续性分布者86例,非连续性分布者10例。病变呈连续性分布者中,直肠炎10例,次全结肠炎9例,全结肠炎15例,左半结肠炎28例,直肠乙状结肠炎24例;非连续性分布者中,每例直肠及回盲部均受累,乙状结肠受累6例,横结肠、降结肠、升结肠受累分别为4、4、3例。结论溃疡性结肠炎病变范围以左半结肠炎和直肠乙状结肠炎为主,镜下表现以黏膜血管纹理改变、黏膜充血水肿、糜烂或溃疡为主。肠镜下病变分布以连续性为主,同时非连续性分布患者比例与既往研究相比有所上升。

Objective To summarize the characteristic of the colonoscopy in the treatment of ulcerative colitis （UC）, and to observe the proportion of patients with inconsecutive distribution lesion. Methods The colonoscopy characteristics of 96 UC patients were observed and analyzed. Results Among the 96 cases received colonoscopy, there were 89 cases with mucous membrane blood vessel texture change, 78 cases with mucous membrane hyperemia and edema, 56 cases with erosion, 45 cases with anabrosis, 16 cases with flated and blunted or even faded haustrum, 12 cases with pseudopolyp, and 4 cases with mucosal bridge. There were 86 cases of consecutive distribution of pathological change, and 10 cases of inconsecutive distribution. Among the cases of consecutive distribution, there were 10 cases of proctitis, 9 cases of subtotal colitis, 15 cases of pancolitis, 28 cases with left half colitis and 24 cases with proctosigmoiditis. Among the case of inconsecutive distribution, every case had involved rectum and ileocecal junction. There were 6 cases with involved colon sigmoideum, 4 cases with involved colon transversum, 4 cases with involved descending colon, and 3 cases with ascending colon. Conclusion The pathological change of UC mainly occurs as left half colitis and proctosigmoiditis. Blood vessel texture change, mucous membrane hyperemia and edema, erosion, and anabrosis are main manifestations in colonoscopy. The distribution of pathological change is mainly consecutive, and proportion of patients with inconsecutive distribution rises, compared with previous study.