论文部分内容阅读
目的 分析克罗恩病的临床表现、误诊原因和诊疗方法 ,以促进与提高对本病的认识及诊治效果。方法 对近期诊治 31例患者的发病情况、临床表现、内镜及实验室检查结果 ,结合文献报道 ,分析本病的临床特征与诊治方案。结果 患者以青中年为主 ,女略多于男。病变侵犯胃肠道任一部位 ,呈节段性分布 ,常同时侵犯多个部位 ,以结肠及小肠为主 ;腹痛与腹泻为主要的肠道症状 ,但尚有低热、消瘦、贫血及皮肤、关节与肛周疾病等多系统症状。内镜可见跳跃式分布的黏膜充血、水肿、溃疡、息肉、狭窄或铺路石征等破坏与增殖病变并存的特点 ,诊断正确率为 62 9%。活检肉芽肿检出率为 30 8%。B超可探查出肠道并发症。误诊原因 :对本病认识不足 ;肠道病变多部位性 ,致使临床症状多样化 ;过于强调病理学检查及肉芽肿的诊断意义。口服泼尼松对轻 中型患者诱导缓解较氨基水杨酸盐类更迅速 ;免疫制剂为二线药物 ,个体间疗效不一 ;2 0例接受强化性营养支持治疗 ,具有辅助治疗作用。 1 6例手术治疗收到较好疗效。结论 本病发病数明显增多 ,临床表现缺乏特异性 ;内镜联合活检 ,加强临床与病理医师沟通是及时和正确诊断的关键。治疗宜个体化选择方案 ,手术具有积极意义。
Objective To analyze the clinical manifestations, causes of misdiagnosis and diagnosis and treatment of Crohn ’s disease in order to promote and improve the understanding of the disease and the effect of diagnosis and treatment. Methods The recent diagnosis and treatment of 31 cases of patients with clinical manifestations, endoscopic and laboratory findings, combined with the literature, analysis of the clinical features of the disease and diagnosis and treatment programs. Results The patients were mostly young and middle-aged, slightly more female than male. Lesions invading any part of the gastrointestinal tract, was segmental distribution, often multiple parts of the same time, mainly in the colon and small intestine; abdominal pain and diarrhea as the main intestinal symptoms, but there are low fever, weight loss, anemia and skin, Joint and perianal disease and other multi-system symptoms. Endoscopic findings of leaping distribution of mucosal congestion, edema, ulcers, polyps, stenosis or paving stones and other characteristics of the coexistence of damage and proliferation of lesions, the diagnostic accuracy was 62 9%. Biopsy granuloma detection rate was 30 8%. B-probe probable intestinal complications. Causes of misdiagnosis: lack of knowledge of the disease; multi-site intestinal disease, resulting in the diversification of clinical symptoms; too much emphasis on pathological examination and granuloma diagnostic significance. Oral prednisone in patients with mild to moderate induction of relief than aminosalicylates more rapid; immunosuppressive agents for the second-line drugs, the efficacy of different individuals; 20 cases of intensive nutritional support therapy, with adjuvant therapy. 1 6 cases of surgical treatment received a good effect. Conclusion The incidence of this disease increased significantly, the clinical manifestations of the lack of specificity; endoscopic biopsy, to enhance clinical and pathological communication is the key to timely and correct diagnosis. Treatment should be individualized options, surgery has a positive meaning.