深在性囊性结肠炎的临床特征与治疗—附一例报道与中文文献分析

Abstract

目的：分析深在性囊性结肠炎的临床表现与诊疗结果，以提高其诊疗水平。方法：综合分析国内近20年文献报道及作者病例(共17例)。结果：平均发病年龄34.0岁、男女比例为7:10，发病部位分别为回盲部6例、直肠4例、升结肠3例、结肠弥漫性病变2例、降结肠及乙状结肠各1例。临床表现以腹痛伴血便8例(最多)，其次腹痛伴腹泻、腹部包块及间断血便各2例，肠梗阻、肠套叠及转移性右下腹部疼痛各1例。体检发现腹部包块8例、直肠指诊发现直肠肿物4例、贫血2例、腹膜炎体征1例及体征阴性2例。本组17例腹部超声提示腹腔肿块8例、局限性肠壁增厚2例及未见异常7例。CT扫描发现腹腔肿块8例、局限性肠壁增厚5例及未发现异常4例。15例内镜检查中14例发现病灶和1例黏膜组织活检确诊。8例钡剂灌肠检查发现肠腔局限性狭窄2例、肠壁肿瘤性病变5例及弥漫性病变1例。所有病例均实施手术治疗，术后恢复良好、痊愈出院，随访期间无疾病复发。结论：诊断明确病例首选内科保守治疗，而手术治疗适应于与恶性疾病鉴别困难病例。 Objective: The clinical manifestation and treatment results of colitis cystica profunda were analyzed to improve the level of diagnosis and treatment. Methods: The nearly twenty-year Chinese literature report of colitis cystica profunda and our report were comprehensively analyzed. Results: The average age was 34.0 years, with the male to female ratio of 7:10; the lesion location was iliocecum in 6 cases, rectum in 4, ascending colon in 3, diffuse colon disease in 2, descending colon and sigmoid colon in each of the 1 case. The clinical manifestation was leaded by abdominal pain with bloody stool in 8 cases, followed by abdominal pain with diarrhea and abdominal mass with intermittent bloody stool in each of the 2 cases, intestinal obstruction in one, intussusceptions in one and shifting right abdominal pain in one. Physical examination revealed abdominal mass in 8 cases, rectal mass found by digital exam in 4 cases, anemia in 2 cases, peritonitis sigh in one and negative finding in 2 cases. All 17 cases underwent abdominal ultrasound; abdominal mass was detected in 8 cases, localized thickening of colorectal wall in 2 cases, and no abnormal finding in 7 cases. CT scanning revealed abdominal mass in 8 cases, localized thickening of colorectal wall in 5 cases, and no abnormal finding in 4 cases. Colorectal lesions were observed in fourteen of 15 cases with endoscopy, and colitis cystica profunda was determined by endoscopy with biopsy in one case. Barium examination was in 8 cases, localized thickening of colorectal wall in 2 cases, tumor-like lesion in 5 cases and diffuse disease in one. All cases underwent surgery, with smooth recovery and discharge, and there was no recurrence of disease during the follow-up. Conclusions: The medical conservative treatment was the choice of therapy, and the surgery is indicated in colitis cystica profunda cases when it is difficult to distinguish with malignant disease.