腸管結核10例の臨床診断と内視鏡検査の検討

Clinical diagnosis and endoscopic analysis of 10 cases of intestinal tuberculosis.

• Shuangshuang Lu
• Jinjin Fu
• Yongxin Guo
• Jin Huang

抄録

腸管結核（ITB）の臨床的特徴を分析し、内視鏡検査と粘膜生検の診断価値に注意を払い、内視鏡検査下でのITBの非定型症状の認識を改善し、誤診や診断ミスを減らすために、2015年1月1日から現在までに常州第二人民病院に入院し、最終的にITBと診断された10人の患者の臨床データをレトロスペクティブに分析した。患者の基本情報、病歴、臨床症状、コンピュータ断層撮影（CT）、内視鏡検査の結果をレトロスペクティブに分析した。病理検査の結果を分析して整理したところ、10名中、男女比は7：3、腹痛10名（100％）、下痢3名（30％）、血便2名（20％）であった。結核T細胞検査の陽性率は75％（6/8）、胸部高分解能CTの診断率は60％、腹部高分解能CTの異常率は66.7％（6/9）であった。大腸内視鏡検査では、病変は主に回腸（70％）と上行結腸（60％）が関与していた。病変の多くは腸管狭窄（60％）、円形潰瘍（50％）であった。少数例では寒冷膿瘍（20％）、瘢痕憩室（10％）であった。病理所見は肉芽腫形成と多核巨細胞（60％）がほとんどであった。症例肉芽腫の検出率は20％であった。ITBの診断には内視鏡検査と粘膜生検が重要である。臨床症状や内視鏡検査では非定型的な徴候を示す患者もいた。このように、ITBの内視鏡検査の特徴に対する臨床医の認識を高めることで、ITBの診断レベルを向上させることができると考えられる。

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.