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影像学在克罗恩病并发肠腔狭窄诊断及随访中的价值

庄楠 李文波 朱庆莉

庄楠, 李文波, 朱庆莉. 影像学在克罗恩病并发肠腔狭窄诊断及随访中的价值[J]. 协和医学杂志, 2021, 12(2): 238-243. doi: 10.12290/xhyxzz.20190117
引用本文: 庄楠, 李文波, 朱庆莉. 影像学在克罗恩病并发肠腔狭窄诊断及随访中的价值[J]. 协和医学杂志, 2021, 12(2): 238-243. doi: 10.12290/xhyxzz.20190117
ZHUANG Nan, LI Wen-bo, ZHU Qing-li. Value of Imaging in Diagnosis and Follow-up of Crohn's Disease Complicated with Intestinal Stricture[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 238-243. doi: 10.12290/xhyxzz.20190117
Citation: ZHUANG Nan, LI Wen-bo, ZHU Qing-li. Value of Imaging in Diagnosis and Follow-up of Crohn's Disease Complicated with Intestinal Stricture[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(2): 238-243. doi: 10.12290/xhyxzz.20190117

影像学在克罗恩病并发肠腔狭窄诊断及随访中的价值

doi: 10.12290/xhyxzz.20190117
基金项目: 

国家自然科学基金 81771855

中国医学科学院医学与健康科技创新工程 2017-I2M-1-006

详细信息
    通讯作者:

    朱庆莉  电话:010-69155493, E-mail: zqlpumch@126.com

  • 中图分类号: R574; R445

Value of Imaging in Diagnosis and Follow-up of Crohn's Disease Complicated with Intestinal Stricture

Funds: 

National Natural Science Foundation of China 81771855

CAMS Innovation Fund for Medical Sciences 2017-I2M-1-006

More Information
    Corresponding author: ZHU Qing-li   Tel: 86-10-69155493, E-mail: zqlpumch@126.com
  • 摘要: 肠腔狭窄是常见的克罗恩病(Crohn's disease,CD)并发症,15%的CD患者在首诊10年内可发展为肠腔狭窄。CD并发肠腔狭窄根据病理类型可分为炎症型、纤维型及混合型,炎症型为主的患者可通过药物治疗缓解症状,而纤维型为主的患者则只能通过介入或手术治疗,故采用影像学手段全面评估狭窄肠段的数目、部位、形态,并区分肠壁炎症和纤维化程度,对于临床决策十分重要。近年来,多项影像学新技术在鉴别狭窄肠壁炎症及纤维化方面取得了较大进展,有望在临床推广应用,进一步提高CD并发肠腔狭窄的诊疗。本文综述主要影像学手段包括内镜、CT、MRI、经腹超声等对肠腔狭窄的诊断价值,以期为临床提供参考。
    作者贡献:庄楠负责文献查询、整理及文章撰写;李文波、朱庆莉负责文章审阅和修改。
    利益冲突:  无
  • 图  1  1例女性患者,42岁,右半结肠切除术后,诊断为克罗恩病,肠镜显示吻合口处狭窄(箭头)

    图  2  1例男性患者,52岁,结肠次全切除术后,计算机断层扫描肠道成像显示吻合口处肠腔狭窄(箭头)

    图  3  1例男性患者,45岁,诊断克罗恩病,经腹超声显示第5组小肠局部肠腔狭窄,近端肠腔扩张(箭头)

    表  1  不同影像学方法诊断CD合并肠腔狭窄的优势和局限性

    影像学方法 优势 局限性
    内镜 直观,可取活检、镜下治疗 不适于肠梗阻患者,具有侵入性
    CTE 非侵入性 需肠道准备,有辐射暴露
    MRI 无辐射,准确度高 价格昂贵,检查时间长
    经腹超声 准确度高,操作简便 易受肠腔内气体干扰
    PET/CT 可准确识别严重病变 价格昂贵,对轻度病变不敏感
    CD:克罗恩病;CTE:计算机断层扫描肠道成像;PET/CT:正电子发射断层显像/计算机体层成像
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出版历程
  • 收稿日期:  2019-06-24
  • 录用日期:  2019-10-30
  • 网络出版日期:  2019-11-29
  • 刊出日期:  2021-05-30

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