182例回肠末端病变的病因分析

Etiological analysis of 182 cases of terminal ileum lesions

目的分析经结肠镜检查发现的回肠末端病变及其病因,为临床诊治提供帮助。方法回顾性分析2009年-2017年在首都医科大学附属北京世纪坛医院进行全结肠镜检查,发现回肠末端病变并行活检病理的182例患者资料。其中,男124例(68.1%),女58例(31.9%),年龄21～83岁,平均(50.3±14.8)岁。分析患者的一般资料、临床特征、结肠镜下表现和随访结果等。结果患者接受全结肠镜检查的常见原因有:健康体检53例(29.1%)、腹痛40例(22.0%)和腹泻26例(14.3%)。发现的回肠末端病变包括:黏膜糜烂119例(65.4%)、溃疡性病变31例(17.0%)、黏膜充血肿胀26例(14.3%)和多发黏膜隆起6例(3.3%)。除回肠末端病变,69例(37.9%)同时发现结肠息肉,14例(7.7%)发现结肠散在充血、糜烂或溃疡,8例(4.4%)发现结肠憩室。确定诊断:22例诊断非甾体抗炎药(NSAIDs)相关肠病,14例考虑NSAIDs和过敏相关疾病均有可能,12例诊断嗜酸性粒细胞性胃肠炎(EGE),6例诊断为淋巴滤泡增生,4例患者诊断溃疡性结肠炎(UC),2例患者诊断IgA血管炎,1例诊断肠结核,1例诊断隐源性多灶性溃疡性狭窄性小肠病(CMUSE),1例克罗恩病(CD)。绝大多数病变(119/182)未找到明确病因,诊断为非特异性回肠末端病变。结论回肠末端病变的病因多样,临床表现不同,内镜下无特征性表现,部分诊断困难。EGE和NSAIDs相关胃肠病为不可忽视的病因。即使诊断为非特异性病变仍需长期随访。

Objective To analyze the etiology of terminal ileum lesions by colonoscopy, conducted to help the further diagnosis and therapy. Methods We retrospectively analyzed the demographic data, clinical features,colonoscopy characteristics and follow-up of terminal ileum lesions patients with who accepted a colonoscopy in Beijing shijitan hospital, from 2009 to 2017. Results A total of 182 cases were enrolled. 68.1% and 31.9% was male and female respectively. The mean age was(50.3 ± 14.8) years old(21 ~ 83 years old). The main reasons for patients undergoing the colonoscopy were medical examination(53/182), abdominal pain(40/182) and diarrhea(26/182).The colonoscopy identified erosion(119/182), ulcer(31/182), hyperemia(26/182) and elevated lesions(6/182) in the terminal ileum. Meanwhile, 69(37.9%), 14(7.7%) and 8(4.4%) were found the colon polyp, colon hyperemia/erosion/ulcer and colonic diverticulum, respectively. Ultimately, 22(12.1%), 12(6.6%), 6(3.3%), 4(2.2%), 2(1.1%), 1(0.5%), 1(0.5%) and 1(0.5%) cases were diagnosed by NSAIDs associated intestinal injury, eosinophilic gastroenteritis, lymphatic follicular hyperplasia, ulcerative colitis, IgA vasculitis, intestinal tuberculosis, Crohn’s disease and cryptogenic multifocal ulcerous stenosing enteritis, respectively. And 119(65.4%) cases were diagnosed by nonspecific terminal ileum lesions without any indentified etiologies. Conclusion The etiologies of terminal ileum lesions are diverse, clinical manifestations are different, endoscopic findings are nonspecific, and some are diagnosed difficulty. Eosinophilic gastroenteritis and NSAIDs associated intestinal injury can’t be ignored. The cases still need long-term follow-up, though some diagnosed by nonspecific lesions.