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目的评价内镜及活检病理对回盲部溃疡性病变病因的诊断价值。方法经内镜检查发现回盲部溃疡,结合临床表现和活检病理对证实的回盲部溃疡改变如肠结核病、克罗恩病、溃疡性结肠炎、恶性淋巴瘤、大肠癌(溃疡型)进行鉴别诊断。结果内镜检查对溃疡性结肠炎、大肠癌较易诊断;对肠结核病、克罗恩病、恶性淋巴瘤诊断率不高。内镜组织活检病理形态学研究表明:异型淋巴细胞、异型上皮、类上皮结节合并干酪样坏死分别相对于恶性淋巴瘤、溃疡型大肠癌和肠结核病均有确诊意义(P<0.05);单纯类上皮结节(即结节样肉芽肿)见于克罗恩病和肠结核病,若未发现肠结核干酪样坏死,两者不易鉴别;隐窝脓肿多见于溃疡性结肠炎,但该病理特征诊断意义不强,可见于多种病变。结论回盲部病变以溃疡型病变最为多见。内镜及活检组织病理学检查对回首部溃疡病变的诊断是安全有效的,综合分析其结果可进一步提高诊断准确率。
Objective To evaluate the diagnostic value of endoscopy and biopsy on the etiology of ulcerative lesions in the ileocecal region. Methods The ileocecal ulcers were detected by endoscopy. Combined with clinical manifestations and biopsy pathologies, confirmed ileocecal ulcer changes such as intestinal tuberculosis, Crohn’s disease, ulcerative colitis, malignant lymphoma, and colorectal cancer (ulcerative type) were performed Differential diagnosis. Results endoscopy for ulcerative colitis, colorectal cancer more easily diagnosed; intestinal tuberculosis, Crohn’s disease, malignant lymphoma diagnosis rate is not high. Endoscopic biopsy histopathological studies showed that: atypical lymphoid cells, atypical epithelium, epithelioid nodules associated with casein-like necrosis were diagnosed with malignant lymphoma, ulcerative colorectal cancer and intestinal tuberculosis (P <0.05); simple Epithelial nodules (ie, nodular-like granulomas) are seen in Crohn’s disease and intestinal tuberculosis, if not found caseous necrosis of intestinal tuberculosis, the two are not easy to identify; crypt abscess more common in ulcerative colitis, but the pathological diagnosis Meaning is not strong, can be seen in a variety of diseases. Conclusion The lesions of the ileocecal region are most common in ulcerative lesions. Endoscopic and biopsy histopathological diagnosis of head ulcer lesions is safe and effective, a comprehensive analysis of the results can further improve the diagnostic accuracy.