内镜对炎症性肠病临床处理诊断价值.pptVIP

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 Company Logo ECCO Statement 3F (2010) 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 Company Logo 2010年ECCO关于CD病理特征的声明 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 series, rather than a single rectal biopsy, produced the largest diagnostic improvement.” Company Logo 单中心临床小组的经验：2009.1. — 2010.9. Company Logo 6个图像, 哪个诊断为CD或UC？ Company Logo 以一患者为例 女性，75岁，腹泻、腹痛、粘液血便2周入院 发病前进食过海鲜，但没有集体发病。腹痛、腹泻水样便1天就诊。静脉左旋氧氟沙星2天。腹泻腹痛无好转，出现粘液脓血便，3-6次/日，30-10ml/次，无里急后重，无发热。既往无炎症性肠病史 体检肠鸣音6-8次/日，腹部无压痛。其余体征正常 全结肠镜：溃疡性结肠炎（重症），附内镜照片 Company Logo 炎症性肠病入、出院诊断变化分析 病例数35，男性21例，女性14例，年龄2~75岁 来自消化内科、肾内科、内分泌、老年病学科、肛肠外科