直肠帽状息肉病1例并文献复习

Rectal cap polyposis:A case report and literature review

目的探讨直肠帽状息肉病的临床特征,提高对其认识及诊治技术。方法回顾性分析河北省中医院收治的1例直肠帽状息肉病患者的病例资料,并结合已发表的国内外相关文献进行复习。结果患者青年男性,因间断黏液血便就诊,专科查体见直肠下段齿线附近多个半球状肿物突向肠腔,表面糜烂坏死,上覆大量黄白色脓性分泌物,多次取病理活检提示为炎性改变,经保守抗炎对症治疗3个月,患者黏液血便症状改善,但镜下病损无变化,后经手术切除后痊愈,结合术后病理结果,确诊为“直肠帽状息肉病”,随访1年未见复发。结论直肠帽状息肉病是一种临床罕见的非肿瘤性疾病,为炎性息肉的一种特殊类型,临床诊断主要依据镜下特征性“帽状”改变及病理检查结果,保守治疗或可达到缓解症状的目的,但对于保守效果不佳者,根除病灶仍首选手术治疗。

Objective To explore the clinical characteristics of rectal cap polyposis,thus improving its understanding for clinical diagnosis and treatment.Methods Clinical data of a case of rectal cap polyposis treated in the Hebei Province Hospital of TCM were retrospectively analyzed,and relevant literatures published both domestically and internationally were reviewed.Results A young male patient presented for intermittent mucous bloody stool.Specialized physical examination revealed multiple hemispherical masses protruding towards the intestinal cavity near the lower segment of the dentate line,with erosion and necrosis observed on the surface,and covered with massive yellow white purulent secretions.Multiple pathological biopsies suggested inflammatory changes.After conservative anti-inflammatory and symptomatic treatment for 3 months,although the symptom of mucous bloody stool improved,microscopic lesions remained unchangeable.Surgical resection yielded a cure.Combined with postoperative pathological results,the patient was diagnosed as rectal cap polyposis.No recurrence was observed during a 1-year follow-up.Conclusion Rectal cap polyposis is a rare non-tumor disease and a special type of inflammatory polyp.A clinical diagnosis is usually made based on the characteristic“cap-like”changes under the microscope and pathological examination results.Conservative treatment may achieve the goal of relieving symptoms,but surgery for eradicating the lesion is preferred to those with a poor outcome of conservative treatment.