吴建新20130615内镜复查对炎症性肠病临床处理的诊断价值课件.pptVIP

上海交通大学医学院附属新华医院 吴建新 My Talk Can Begin with Or, with The Earliest Report of symptom The Earliest Medical Article IBD: 我国医学文献报道的IBD病例数 我国医学文献报道的IBD病例数 我国医学文献报道的IBD病例数 中文文献IBD 误诊数据与类别 中文文献炎症性肠病的误诊分类统计 溃疡性结肠炎误诊病种统计-A类 溃疡性结肠炎误诊病种统计-B类 克罗恩病误诊病种统计-A类 克罗恩病误诊病种统计-B类 中文文献炎症性肠病的误诊分类统计 挑战诊治IBD的消化专科医师的问题 ECCO Statement 3F (2010) 2010年ECCO关于CD病理特征的声明 6个图像, 哪个诊断为CD或UC？ 以一患者为例 炎症性肠病入、出院诊断变化分析 IBD患者入、出院诊断变化统计(漏诊) IBD患者入、出院诊断变化统计 IBD患者入院出院诊断变化统计 误诊病例最后诊断疾病分类 病例-7 诊断为克罗恩病 内镜复查：个人经验、一孔之见 提镜临床学科之间会诊交流 需要排除的疾病或并发症 国外诊治炎症性肠病医生的素质 Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology （J Clin Pathol 1997;50:93-105） Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology Focal (discontinuous) chronic (lymphocytes and plasma cells) inflammation and patchy chronic inflammation, focal crypt irregularity (discontinuous crypt distortion), and granulomas (not related to crypt injury) are the generally accepted microscopic features that permit a diagnosis of CD [EL2, RGB]. The same features and, in addition, an irregular villous architecture, can be used for analysis of endoscopic biopsy samples from the ileum. If the ileitis is in continuity with colitis, the diagnostic value of this feature should be used with caution [EL2, RG B]. Travis SM, er al. Gut 2010 gt81950A 10/01/06 与会专家一致认为，CD 的特征性病理组织学特征有：局灶性（focal or discontinuous）慢性炎症（非连续性、粘膜浸润以淋巴细胞和浆细为主）和斑片状慢性炎症（patchy chronic inflammation）、局灶性隐窝不规则（非连续性隐窝不规则）和肉芽肿（与隐窝损害无关）等 [EL5, RG D]。内镜下回肠活检标本病理特征除此以外，绒毛结构不规则也作为诊断参考依据。如出现回肠炎症与结肠炎症连续一起时，上述标准应用时需慎重[EL2, RG B] Travis SPL, er al. Gut 2010 gt81950A 10/01/06 J Clin Pathol 2002;55:955-960 J Clin Pathol 2002;55:955-960 “Using a full colonoscopic biopsy s