结肠镜和组织学检查对儿童克罗恩病诊断价值.docVIP

结肠镜及组织学检查对儿童克罗恩病的诊断价值【摘要】 目的 探讨结肠镜诊断儿童克罗恩病的重要性及活检组织学检查的价值。方法 回顾性分析近10年在我院诊治的10例克罗恩病患儿结肠镜下特点及活检组织学特点，分析其诊断价值。 结果 10例患儿中，小肠结肠型6例，结肠型及小肠型克罗恩病各2例。结肠镜下全结肠累及者2例，累及结肠8例中结肠镜下全结肠累及者2例（25.0%）， 左半结肠、右半结肠或横结肠累及者各3例（37.5％），乙状结肠、回盲部累及者各2例（25.0%），直肠累及者1例（12.5％）。结肠镜下表现有节段性分布、溃疡多样性、修复性改变、部分肠管狭窄僵硬等特点。活检组织学以淋巴细胞浸润多见，肉芽肿检出率 22.2％ 。结论 结肠镜检查在克罗恩病诊断中有重要意义，常规结肠镜下活组织学检查缺乏特异性，可多部位、深凿活检以提高阳性率，协助诊断。【关键词】 克罗恩病；结肠镜；组织学；诊断Importance of colonoscopy and biopsy in the diagnosis of pediatric Crohn’s Disease LUO Youyou, CHEN Jie. Department of Internal Medicine, The Childrens Hospital, Medical College, Zhejiang University, Hangzhou 310003, China【Abstract】 Objective To evaluate the importance of endoscopic and histological features when establishing a diagnosis of pediatric Crohn’s disease. Methods The authors retrospectively reviewed the data of endoscopic findings and biopsy on Crohns disease (CD) during a 10 year period from the medical records. Results There were 10 children diagnosed Crohn’s disease. Of these, 8 were colon involved. However, involvement limited to the colon alone was seen in only 2 case. Endoscopically, discontinuous lesions, diverse ulcers, proliferative/regenerative patterns and narrowed bowel lumen were observed. Histologically, lymphocytes aggregation in the lamina propria and submucosa were observed. Non-caseating granulomas were found in 22.2% cases. Conclusions Colonoscopy is valuable in establishing the diagnosis of pediatric Crohn’s disease. Colonoscopic biopsies were short of specificity. Multi-place and deep biopsy are needed to improve the positive rate.【Key words】 Crohn’s disease; colonoscopy; biopsy; diagnose克罗恩病（ Crohn’s Disease, CD）在我国儿童人群中发病率逐年增高，但临床诊断困难，相关报道国内较少。结肠镜结合组织学检查对各种儿童结肠疾病的诊断具有重要意义，但在克罗恩病中的应用以及重要性尚待进一步探讨。我院近年共收治10例克罗恩病患儿，本文就其结肠镜及其活组织检查特点进行分析。1. 对象与方法1.1对象收集我院1998年至2007年的CD患儿共10例。其中女4例，男6例，年龄3.8～13.8岁，平均10.88岁。平均病程2.31月（0.5～6月）。所有病例均符合2001年中华医学会消化病分会制订的CD诊断标准[1]。1.2方法所有病例均行结肠镜检查，对直肠、乙状结肠与左半结肠、横结肠、右半结肠与末端回肠等5个肠段进行探查，并对每一肠段粘膜及肠管病变进行记录。病变部位取活检组织1－5块不等，共28块