超声内镜在结肠克罗恩病微观辨证中的应用

Endoscopic ultrasonography in microcosmic syndrome sifferentiation of colonic Crohn's disease

[目的]归纳总结结肠克罗恩病临床内镜特征,探讨与中医辨证分型之间的相关性。[方法]收集2012年3月~2014年2月在我院就诊的依据临床特征及常规结肠镜检查结果拟诊为克罗恩病的病例,共50例,根据临床特征进行中医辨证,并通过常规内镜、超声内镜对病变发生部位、黏膜形态、病变肠壁各层组织结构和回声改变进行观察,探讨超声内镜下特征与中医辨证分型之间的相关性。[结果]通过超声内镜对病变处观察可提高诊断的准确率,黏膜下层的增厚程度与炎症程度呈正相关,脾虚湿热证及气滞血瘀证内镜下炎症程度更加明显。[结论]超声内镜检查在结肠克罗恩病的中西医结合诊疗中是一种很好的辅助诊断方法。活动期以脾虚湿热证、气滞血瘀证多见,缓解期以脾虚痰湿型、脾肾阳虚型多见。

[Objective]The study is to summarize the endoscopic characteristics of colonic Crohn＇s Disease and to investigate their association with the Traditional Chinese Medicine（TCM）syndrome differentiation.[Methods]Fifty cases of Crohn＇s Disease between Mar 2012 and Feb 2014 were involved,which were diagnosed by clinical characteristics and colonoscopy.The cases were analyzed with syndrome differentiation according to their clinical characteristics and also underwent colonoscopy and endoscopic ultrasonography to investigate the location of the lesion,the mucosal morphology and the echo and the structure of each layer in the lesion.And the association between the characteristics of endoscopic ultrasonography and the TCM syndrome differentiation was also investigated.[Results]The endoscopic ultrasonography was helpful for improving the accuracy of diagnosis.There was a positive correlation between the thickening of the submucosa and the inflammation.The endoscopic inflammatory characteristics were more obvious in the cases of deficiency of the spleen with damp-heat and Qi-stagnation and blood stasis.[Conclusion]Endoscopic ultrasonography is a helpful auxiliary diagnostic study in the diagnosis and treatment of colonic Crohn＇s Disease in the combination of Chinese traditional and western medicine.Deficiency of the spleen with damp-heat and Qi-stagnation and blood stasis are frequently seen in the active phase,while deficiency of the spleen with phlegmatic hygrosis and spleen-kidney yang deficiency are frequently seen in the remission phase.