Bernstein C N, Shanahan F, Anton P A, Weinstein W M
Department of Medicine, University of California, Los Angeles, USA.
Gastrointest Endosc. 1995 Sep;42(3):232-7. doi: 10.1016/s0016-5107(95)70097-8.
Conventional wisdom dictates that ulcerative colitis affects contiguous areas of the colon and is most severe in the rectum, and that the finding of rectal sparing or patchy involvement should raise suspicions of Crohn's disease. We and others have noted occasional rectal sparing and patchy involvement in patients with ulcerative colitis. Therefore, we prospectively studied the prevalence of patchiness, including rectal sparing, in treated cases of ulcerative colitis. Consecutive patients with longstanding ulcerative colitis were studied. The left colon was divided into three zones for scoring degree of activity, and biopsy specimens from each zone were graded for histologic activity by a blinded observer. Patchiness by endoscopy or histology was defined as (1) frank rectal sparing (normal appearance endoscopically; absence of inflammation of the lamina propria and crypts histologically); (2) areas of greater inflammation proximally than distally; or (3) discrete areas of patchiness endoscopically within any one zone. Of 39 patients evaluated, 17 (44%) had endoscopic evidence of patchiness, including 5 (13%) with rectal sparing. Thirteen (33%) had histologic evidence of patchiness, including 6 (15%) with rectal sparing. Both endoscopic and histologic patchiness were seen in 9 patients (23%). The patchy and nonpatchy groups did not differ in regard to the use of rectal therapy. In patients with treated ulcerative colitis, the finding of rectal sparing or patchiness should not necessarily indicate a change in the diagnosis to Crohn's disease.
传统观点认为，溃疡性结肠炎累及结肠的连续区域，且在直肠最为严重，而直肠未受累或呈斑片状受累的情况应引起对克罗恩病的怀疑。我们和其他人都注意到溃疡性结肠炎患者偶尔会出现直肠未受累和斑片状受累的情况。因此，我们对接受治疗的溃疡性结肠炎病例中斑片状病变（包括直肠未受累）的发生率进行了前瞻性研究。对连续性的长期溃疡性结肠炎患者进行了研究。将左半结肠分为三个区域以评估活动度，并由一名不知情的观察者对每个区域的活检标本进行组织学活动分级。内镜或组织学上的斑片状病变定义为：（1）明显的直肠未受累（内镜下外观正常；组织学上固有层和隐窝无炎症）；（2）近端炎症比远端更严重的区域；或（3）内镜下在任何一个区域内出现的离散斑片状区域。在评估的39例患者中，17例（44%）有内镜下斑片状病变的证据，其中5例（13%）有直肠未受累。13例（33%）有组织学上斑片状病变的证据，其中6例（15%）有直肠未受累。9例患者（23%）同时有内镜和组织学上的斑片状病变。斑片状病变组和非斑片状病变组在直肠治疗的使用方面没有差异。在接受治疗的溃疡性结肠炎患者中，直肠未受累或斑片状病变的发现不一定意味着诊断应改为克罗恩病。
