溃疡性结肠炎内镜检查的研究进展.doc

溃疡性结肠炎内镜检查的研究进展 孙永刚（综述） 房殿春2（审校） （ 1解放军535医院消化科 湖南 怀化418000；2 第三军医大学西南医院全军消化研究所， 重庆 400038） 　摘要: 近年我国溃疡性结肠炎（Ulcerative Colitis，UC）患病率有逐渐增加的趋势，长期患有UC的病人罹患结肠癌的风险性增高，在溃疡性结肠炎的检查中内镜检查是最直接、准确、可靠的诊断方法，对该病的诊断、疾病活动性以及恶变的监测均具有重要意义。目前，有多种内镜检查方法用于临床：普通电子内镜、放大内镜、染色内镜、荧光内镜、共聚焦激光显微内镜检查胶囊内镜光学相干断层摄影术窄谱成像技术等。各种方法在溃疡性结肠炎的检查中各有其独特的价值在临床中应结合实际情况选择合适的检查方法来评估病情以制定合理有效的治疗方案关键词:内镜; Progress of Endoscopic detection of Ulcerative Colitis SUN Yong-gang1 , FANG Dian-chun2 (1 Department of Gastroenterology, 535 Hospital of PLA, Huaihua 418000；2 Department of Gastroenterology , Southwest Hospital , Third Military Medical University , Chongqing 400038 , China) Abstract: The incidence of ulcerative colitis in China has been increasing in recent years. Patients with longstanding ulcerative colitis are at increased risk of developing colorectal cancer. Endoscopic detection is one of the most direct and accurate detection methods to diagnose ulcerative colitis. At present, many kinds of endoscopies are used in clinical practice. They are traditional electric colonoscopy, magnification colonoscopy, Magnifying chromoscopy, fluorescence endoscope, confocal laser endomicroscopy, capsule endoscopy, optical coherence tomography, narrow band imaging, Each kind of endoscopy has its unique value in the detection of ulcerative colitis respectively. Feasible screening methods according to practical condition in clinic should be chosen in order to formulate reasonable and effective therapeutic regimen. Key words: Ulcerative Colitis; Endoscopic detection 一、概论 溃疡性结肠炎（Ulcerative Colitis，UC）是一种原因不明的直肠、结肠炎症性疾病，本病可发生于任何年龄, 但以20-40岁为多见, 男女发病率无显著差别。长期患有UC的病人罹患结肠癌的风险性增高[1. 2.]。UC的病因发病机理迄今尚未完全明确。现代医学认为, 可能与免疫、遗传、精神及感染因素有关。随着免疫学研究的不断深入, 越来越多的证据表明免疫因素具有重要的致病作用, 精神因素和感染因素可能为诱发因素UC的主要病理表现为病变部位局限于结肠粘膜, 以溃疡糜烂为主多累及远端结肠, 可向近端结肠蔓延以致遍及全结肠。临床特征为腹泻、腹痛、粘液血便、里急后重等, 部分伴有肠外表现，如脱髓鞘疾病、多发性硬化症、视神经炎[3],骨质疏松[4]等。UC病程迁延, 反复发作，治疗难度大, 疗程长而且治愈后易于复发。本文就溃疡性结肠炎的的研究进展做一简要综述。 1）结肠镜检查（colonoscopy） 可见黏膜弥漫性充血、水肿，正常可见到的黏膜下树枝状小血管变得模糊不清或消失，黏膜面呈颗粒状，脆性增加，轻触