151例回盲部病变临床诊治分析
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Clinical analysis of 151 cases of ileocecal lesions
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    目的:回顾分析回盲部病变的病因及临床特征,以提高回盲部病变诊治水平。方法:收集2011年1月至2016年12月重庆医科大学附属第一医院收治的151例回盲部病变的完整临床资料,从临床表现、病因、检查方法和诊断逐一探讨。结果:151例回盲部病变中肿瘤最多见,占58.9%,其次为克罗恩病(Crohn’s disease,CD)、肠结核(intestinal tuberculosis,ITB)、溃疡性结肠炎(ulcerative colitis,UC)、息肉,分别占14.5%、10.5%、3.9%、3.3%,其余少见病因有白塞综合征、憩室、非特异性炎症、黏液囊肿等。男80例,女71例,平均年龄(55.1±18.3)岁。病因的男女构成比差异无统计学意义( χ2=0.079,P=0.779)。肿瘤性疾病多见于老年人(56/89,62.9%),非肿瘤性疾病好发于青年人(30/61,49.2%),差异有统计学意义( χ2=24.214,P=0.000)。临床表现主要包括腹痛(112/151,74.2%)、体质量减轻(74/151,49.0%)、腹泻(61/151,40.4%)、腹部包块(45/151,29.8%)、消化道出血(41/151,27.2%)。辅助检查以纤维结肠镜加病理活检有效阳性率最高(104/131,79.4%),腹部增强CT次之(95/133,71.4%)。非肿瘤性疾病误诊率为21.6%(11/51),以CD和ITB的误诊居多(10/38)。结论:回盲部病变临床表现缺乏特异性,病因以肿瘤性疾病为主,纤维结肠镜加病理活检是其主要检查方法;非肿瘤性疾病易误诊,以CD和ITB多见,纤维结肠镜加病理活检及腹部增强CT等辅助检查配合诊疗随访,可有效提高临床诊治水平。

    Abstract:

    Objective:To improve the understanding and diagnosis and treatment of the ileocecal lesions by retrospectively analyzing the etiology and clinical features of 151 cases of ileocecal lesions. Methods:The clinical data of 151 patients with the ileocecal lesions were collected. All patients were admitted to the First Affiliated Hospital of Chongqing Medical University from 2011 January to 2016 December. The manifestation,etiology,check methods and diagnosis were analyzed. Results:Tumor was the most frequent cause of the ileocecal lesions,accounting for 58.9%(89/151) of all cases,followed by Crohn’s disease(CD),intestinal tuberculosis(ITB),ulcera-tive colitis(UC),intestinal polyps,accounting for 14.5%,10.5%,3.9%,3.3% respectively. Other rare causes were Behcet’s diease,diverticulum,nonspecific inflammatory,mucous cyst etc. There were 80 males and 71 females,with an average age of (55.1±18.3). There was no significant difference in the ratio of male to female in etiology(χ2=0.079,P=0.779). Neoplastic diseases are more common in the elderly(56/89,62.9%),and non neoplasitc diseases occur in young people(30/61,49.2%),with statistical significance( χ2=24.214,P=0.000). The mainly clinical manifestations were abdominal pain,diarrhea,tarry stool,bloody stool,abdominal mass,weight loss etc. The most effective check method was colonoscopy and biopsy,followed by enhanced computed tomography of abdominal. The misdiagnosis rate of non neoplastic diseases was 21.6%(11/51),and most of them were misdiagnosed by CD and ITB(10/38). Conclusion:The clinical manifestations of ileocecal lesions are lack of specificity,the main causes of which are neoplastic diseases,and colonoscopy and biopsy is the main examination method. Non neoplastic diseases are easy to be misdiagnosed,mainly in CD and ITB,colonoscopy and biopsy and abdominal enhanced CT and other auxiliary examinations coupled with followed-up can effectively improve the clinical diagnosis and treatment.

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冉婕熙,高青.151例回盲部病变临床诊治分析[J].重庆医科大学学报,2019,(3):352-

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  • 在线发布日期: 2019-04-30
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