Lu Shuangshuang, Fu Jinjin, Guo Yongxin, Huang Jin
School of Medical, Dalian Medical University, Dalian.
Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
Medicine (Baltimore). 2020 Jul 10;99(28):e21175. doi: 10.1097/MD.0000000000021175.
To analyze the clinical characteristics of intestinal tuberculosis (ITB), pay attention to the diagnostic value of endoscopy and mucosal biopsy, improve the recognition of atypical manifestations of ITB under endoscopy, and reduce misdiagnosis and missed diagnosis.The clinical data of 10 patients who were hospitalized in Changzhou second people's Hospital and finally diagnosed as ITB from January 1, 2015 to present were analyzed retrospectively. The basic information, medical history, clinical manifestations and computed tomography (CT), endoscopy of the patients was analyzed retrospectively. The results of pathological examination were analyzed and sorted out.Among the 10 patients, the ratio of male to female was 7:3, 10 (100%) had abdominal pain, 3 (30%) had diarrhea and 2 (20%) had bloody stool. The positive rate of tuberculosis T cell test was 75% (6/8), the diagnostic rate of chest high resolution CT was 60%, and the abnormal rate of abdominal high-resolution CT was 66.7% (6/9). Colonoscopy showed that the lesions mainly involved ileocecum (70%) and ascending colon (60%). Most of the lesions were intestinal stenosis (60%) and circular ulcer (50%). In a few cases, cold abscess (20%) and scar diverticulum (10%). Most of the pathological manifestations were granuloma formation and multinucleated giant cells (60%). The detection rate of caseous granuloma was 20%.The general condition and clinical manifestations of patients with ITB are not specific. Endoscopy and mucosal biopsy are of great significance for its diagnosis. The clinical manifestations and endoscopy of some patients showed atypical signs. Therefore, the combination of multi-disciplinary team models and the enhancement of clinician's recognition of the characteristics of endoscopic examination of ITB can improve us the diagnosis level of ITB.
分析肠结核（ITB）的临床特征，关注内镜检查及黏膜活检的诊断价值，提高对ITB内镜下非典型表现的认识，减少误诊和漏诊。回顾性分析2015年1月1日至今在常州市第二人民医院住院并最终诊断为ITB的10例患者的临床资料。对患者的基本信息、病史、临床表现及计算机断层扫描（CT）、内镜检查结果进行回顾性分析，并整理病理检查结果。10例患者中，男女比例为7:3，10例（100%）有腹痛，3例（30%）有腹泻，2例（20%）有便血。结核T细胞检测阳性率为75%（6/8），胸部高分辨率CT诊断率为60%，腹部高分辨率CT异常率为66.7%（6/9）。结肠镜检查显示病变主要累及回盲部（70%）和升结肠（60%）。病变多为肠腔狭窄（60%）和环形溃疡（50%）。少数为寒性脓肿（20%）和瘢痕憩室（10%）。病理表现多为肉芽肿形成及多核巨细胞（60%）。干酪样肉芽肿检出率为20%。ITB患者的一般情况和临床表现不具有特异性。内镜检查及黏膜活检对其诊断具有重要意义。部分患者的临床表现及内镜检查显示非典型征象。因此，多学科团队模式的联合应用及提高临床医生对ITB内镜检查特征的认识，可提高ITB的诊断水平。
