隐源性多灶性溃疡性狭窄性小肠炎八例诊疗经验

Experience in diagnosis and treatment of cryptogenic multifocal ulcerous stenosing enteritis

目的观察隐源性多灶性溃疡性狭窄性小肠炎(cryptogenic multifocal ulcerous stenosing enteritis, CMUSE)病人的临床特征,结合文献回顾完善该病的诊断思路及治疗策略。方法 2018年1月~2019年12月接受内外科治疗的CMUSE病人8例,观察指标包括临床症状、实验室检查、影像学或内镜(小肠镜/胶囊内镜)、病理检查、治疗效果。结果 7例病人行手术治疗,1例行保守治疗。实验室检查均有不同程度的贫血及潜血阳性,平均血沉值无明显异常。腹部CT增强/MRI均显示病变肠壁节段增厚明显。手术治疗组可见肠管明显环形狭窄。药物治疗组激素减量时间节点,分别为出院后1个月、2个月、4个月。平均随访时间8个月,保守治疗病人此间无明显腹痛腹泻症状及药物治疗不良反应,手术病人无明显近期并发症。结论 CMUSE的误诊率较高,内镜检查的临床意义较炎症指标更为显著,纳入标准应较其他炎症性肠病更为严格。小肠部分切除+侧侧吻合术对反复发作的病人具有更高的优先级。

Objective To observe the clinical features of patients with cryptogenic multifocal ulcerative ulcerous stenosing enteritis(CMUSE),and to improve the diagnosis and treatment strategy of CMUSE combined with literature review.Methods The clinical and follow-up data of 8 patients with CMUSE who received medical and surgical treatment in our center from January 2018 to December 2019 were reviewed retrospectively.The observation indexes included clinical symptoms, laboratory examination, imaging or endoscopy(enteroscopy/capsule endoscopy),pathological examination and therapeutic effect.Results 7 patients were treated by operation and 1 patient was treated conservatively.Laboratory tests showed varying degrees of anemia and occult blood positive, and the average ESR was not significantly abnormal.Abdominal CT/MRI showed that the intestinal wall was thickened obviously.Circular stenosis of intestine could be seen in the surgical treatment group.The time of hormone reduction in the drug treatment group were 1 month, 2 months and 4 months after discharge, respectively.The average follow-up time was 8 months.The conservative treatment patients had no obvious symptoms of abdominal pain, diarrhea and adverse reactions of drug treatment, and the surgical patients had no obvious short-term complications.Conclusion The misdiagnosis rate of CMUSE is high, and the clinical significance of endoscopy is more significant than that of inflammation, and the inclusion criteria should be more stringent than other inflammatory bowel diseases.Partial small bowel resection with side-to-side anastomosis is a higher priority for patients with recurrent attacks.