水灌肠超声对溃疡性结肠炎和克罗恩病的诊断及鉴别诊断

Diagnosis and differential diagnosis of ulcerative colitis and Crohn's disease by hydrocolonic sonography.

作者信息

Limberg B, Osswald B

机构信息

Department of Internal Medicine, Clinic Wolfenbüttel, Academic Hospital, University of Göttingen, Braunschweig, Germany.

出版信息

Am J Gastroenterol. 1994 Jul;89(7):1051-7.

PMID:8017364

Abstract

OBJECTIVES

The entire length of the colon, starting at the rectosigmoid junction and ending at the cecum, can be visualized by transabdominal sonography after retrograde water instillation into the colon. By this method, termed hydrocolonic sonography, it is possible to evaluate in detail the lumen, the colon wall, and the surrounding tissue. Five layers of different echogenicity can be differentiated within the colon wall.

METHODS

In a prospective study of 440 patients, we compared the value of conventional abdominal sonography and hydrocolonic sonography with that of colonoscopy, in the diagnosis and differential diagnosis of ulcerative colitis and colonic Crohn's disease.

RESULTS

In 93% of patients with Crohn's disease, the normal five-layer structure of the colonic wall was no longer in evidence, and the wall appeared hypoechogenic and clearly thickened. In contrast, in patients with ulcerative colitis, the five-layer structure could clearly be discerned, and although the colon wall remained hypoechogenic, it was only moderately thickened. Colonic Crohn's disease and ulcerative colitis were detectable by hydrocolonic sonography, with a sensitivity of 96% and 91%, respectively, whereas the sensitivity achieved by conventional abdominal sonography was only 71% and 62%, respectively. Furthermore, hydrocolonic sonography made possible the differentiation of Crohn's disease from ulcerative colitis in 93% of the cases.

CONCLUSION

This new diagnostic procedure could thus advantageously be introduced for the diagnosis, differential diagnosis, and follow-up of patients with chronic inflammatory large bowel diseases.

摘要

目的

通过向结肠逆行注水后经腹部超声检查，可观察到从直肠乙状结肠交界处至盲肠的整个结肠长度。通过这种称为水灌肠超声检查的方法，能够详细评估肠腔、结肠壁及周围组织。结肠壁内可区分出五层不同回声性的结构。

方法

在一项对440例患者的前瞻性研究中，我们将传统腹部超声检查和水灌肠超声检查的价值与结肠镜检查在溃疡性结肠炎和结肠克罗恩病的诊断及鉴别诊断中的价值进行了比较。

结果

在93%的克罗恩病患者中，结肠壁正常的五层结构消失，肠壁呈低回声且明显增厚。相比之下，在溃疡性结肠炎患者中，五层结构可清晰辨别，尽管结肠壁仍为低回声，但仅轻度增厚。水灌肠超声检查可检测出结肠克罗恩病和溃疡性结肠炎，敏感性分别为96%和91%，而传统腹部超声检查的敏感性分别仅为71%和62%。此外，水灌肠超声检查在93%的病例中能够区分克罗恩病和溃疡性结肠炎。