392例小肠溃疡性病变的临床研究

Clinical Research of Small Intestinal Ulcer in 392 Cases

目的分析小肠溃疡性病变的病因构成、内镜表现及临床特点,为临床诊治提供依据。方法选取2010年1月至2017年8月于湘雅医院经小肠镜、胶囊内镜或在外院已行小肠镜、胶囊内镜诊断为小肠溃疡的患者,收集患者的临床资料进行回顾性分析。结果392例患者诊断为小肠溃疡,病因排序为克罗恩病(68.37%)、肠结核(10.71%)、非特异性小肠炎(7.40%)。常见的主诉是腹痛(56.89%)、消化道出血(14.80%),主要分布于20-39岁组(39.80%),男女为4.851。小肠镜及胶囊内镜小肠溃疡的检出率分别为24.34%及12.25%。溃疡92.49%多发;常见溃疡部位排序是回肠(61.66%)、空肠(17.62%)、空回肠均累及(16.84%);小肠镜下纵行、节段样、沟槽样、铺路石样、鼠咬状的检出率均高于胶囊内镜。内镜病检常见病变为粘膜慢性炎(检出率91.04%),手术病检常见病变检出率顺次为溃疡56.10%、粘膜慢性炎36.59%、肠壁全层炎34.15%。结论小肠溃疡性病变病因多样,临床表现不具有特异性,胶囊内镜和小肠镜有助于小肠溃疡性病变的诊断,病理活检有重要价值,CT检查对诊断有一定的辅助作用,全消化道钡餐意义不大。

Objective:To analyze etiology,endoscopic and clinical features of intestinal ulcer to contribute to diagnosis and treatment.Methods:Clinical data of patients who were diagnosed as small intestinal ulcer by Doubleballon Enteroscopy(DBE),Capsule Endoscopy(CE) from January 2010 to August 2017 at the Xiangya Hospital or other hospitals were collected.Results:392 patients were diagnosed as small intestinal ulcer.Causes were followed by Crohn’s disease(68.37%),intestinal tuberculosis(10.71%) and non-specific enteritis(7.40%).The main complaints were abdominal pain(56.89%) and gastrointestinal bleeding(14.80%).It was mainly distributed in the 20-39 year old group(39.80%) with male to female ratio of 4.85:1.The detection rates of small intestinal ulcer in DBE and CE were24.34% and 12.25% respectively.92.49% ulcers were multiple.The sites of ulcer were followed by ileum(61.66%),jejunum(17.62%),and jejunoileum(16.84%).The detection rate of some ulcer morphology in DBE was higher than that of in CE,such as longitudinal or segmental ulcers.Endoscopic biopsy mainly manifested as chronic mucosal inflammation(91.04%).The detection rates of surgical biopsy were 56.10% for ulcers,36.59% for chronic mucosal inflammation and 34.15% for full layer inflammation of intestinal wall.Conclusion:The causes of small intestinal ulcer are complex,and the clinical manifestations are not specific.DBE and CE are conductive to diagnosis of small intestinal ulcer,and biopsy has great significance.CT examination has certain diagnostic value.Barium meal is not effective in diagnosis.