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1例慢性结肠憩室炎的循证诊疗

于子清 唐晓妍 吴斌 杨红

于子清, 唐晓妍, 吴斌, 杨红. 1例慢性结肠憩室炎的循证诊疗[J]. 协和医学杂志, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
引用本文: 于子清, 唐晓妍, 吴斌, 杨红. 1例慢性结肠憩室炎的循证诊疗[J]. 协和医学杂志, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
YU Ziqing, TANG Xiaoyan, WU Bin, YANG Hong. Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585
Citation: YU Ziqing, TANG Xiaoyan, WU Bin, YANG Hong. Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(1): 209-214. doi: 10.12290/xhyxzz.2022-0585

1例慢性结肠憩室炎的循证诊疗

doi: 10.12290/xhyxzz.2022-0585
基金项目: 

国家自然科学基金 81970495

北京市自然科学基金 7202161

首都卫生发展科研专项 2022-2-4014

中国医学科学院医学与健康科技创新工程 2021-I2M-1-001

详细信息
    通讯作者:

    杨红, E-mail: yangh@pumch.cn

  • 中图分类号: R574.62

Evidence-based Treatment with Chronic Colonic Diverticulitis: A Case Report

Funds: 

National Natural Science Foundation of China 81970495

Natural Science Foundation of Beijing 7202161

The Capital Health Research and Development of Special 2022-2-4014

CAMS Innovation Fund for Medical Sciences 2021-I2M-1-001

More Information
  • 摘要: 结肠憩室炎是一种十分常见的胃肠道疾病,可为急性或慢性病程。本文报道1例慢性结肠憩室炎患者的诊疗经过。该患者临床表现不典型,影像学检查示占位性病变可能性大,PET/CT示代谢增高灶,急性期结肠镜检查可见黏膜隆起、病理回报为炎症,但仍需与结直肠癌、炎症性肠病进行鉴别。综合考虑后予以随访观察的建议,并最终明确诊断。该患者的诊治经过体现了循证医学在疾病诊断与治疗中的重要意义。
    专家点评:
    中国医学科学院北京协和医院消化内科  杨红教授
    结肠憩室炎反复或慢性持续发作导致的炎症反应、肉芽组织增生与部分CRC患者的表现存在很大程度的相似之处,加上临床症状缺乏特异性,导致二者的鉴别诊断存在一定困难,影响后续治疗决策的制订。该患者为老年女性、慢性病程,外院检查无法除外乙状结肠占位性病变,此次住院评估后考虑乙状结肠病灶暂无恶变证据,嘱患者定期随访。在为期1年的随访过程中患者肠壁增厚、乙状结肠隆起明显好转,结肠憩室炎得以明确诊断。循证医学引入中国已有20余年并得到了广泛应用,其核心思想是予以患者关照和尊重,将循证医学融入日常的临床工作中无疑会为患者带来便利。在综合最佳证据、明确证据可信度与权衡获益及风险后,基于循证医学证据对该患者的病情作出个体化评估,有助于明确诊断思路并厘清后续治疗方法、避免有创操作,为患者提供最优的诊疗路径。
    作者贡献:于子清负责收集资料、撰写论文;吴斌、唐晓妍负责审阅论文;杨红负责修订论文。
    利益冲突:所有作者均声明不存在利益冲突
  • 图  1  结肠镜检查示乙状结肠局部肿胀,肠腔轻中度狭窄,黏膜表面糜烂(2021年6月18日)

    图  2  结肠CT示乙状结肠局部结节状突起(箭头,2021年6月28日)

    图  3  结肠镜检查示结肠多发小憩室(2022年7月8日)

    表  1  不同检查方式对结肠憩室炎诊断价值比较

    第一作者(年份) 检查方式 样本(n) Se(%, 95% CI) Sp(%, 95% CI) LR+(95% CI) LR-(95% CI)
    Qaseem等[6],Balk等[7](2022年) CT 684 94(97~97) 99(90~99.9) 78.4(8.7~706.6) 0.06(0.03~0.13)
    Laméris等[8](2008年) 超声 630 92(80~97) 90(82~95) 9.6(5.0~18.6) 0.09(0.04~0.23)
    Andeweg等[9](2014年),Liljegren等[10](2007年) CT 684 95(91~97) 96(90~100) 30.62(16.07~58.36) 0.10(0.07~0.15)
    Andeweg等[9](2014年) 超声 698 90(76~98) 90(86~94) 12.83(7.42~22.19) 0.12(0.08~0.17)
    Andeweg等[9](2014年) MRI 57 98 70~78 4.40(1.30~14.96) 0.03(0.004~0.20)
    Se:灵敏度;Sp:特异度;LR+:阳性似然比;LR-:阴性似然比
    下载: 导出CSV

    表  2  结肠憩室炎患者后续罹患CRC的风险

    第一作者(年份) 样本(n) 结肠憩室炎发生癌前病变的风险(OR) 结肠憩室炎发生CRC的风险(%,95% CI) 单纯性结肠憩室炎发生CRC的风险(%,95% CI) 复杂性结肠憩室炎发生CRC的风险(%,95% CI) 复杂性/单纯性憩室炎发生CRC的风险比较(RR,95% CI)
    Qaseem等[13],Balk等[14](2022年) 1721/2635 0.62 - - - -
    Koo等[15](2020年) 31 741 - 1.67(1.24~2.14) 1.22(0.63~1.97) 6.14(3.20~9.82) 5.033(3.714~7.930)
    Sharma等[16](2014年) 1970 - 1.6(0.9~2.8) 0.7(0.3~1.4) 10.8(5.2~21.0) -
    de Vries等[17](2014年) 2490 - - 1.16(0.72~1.9) - -
    CRC: 结直肠癌;-:无相关数据
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-10-09
  • 录用日期:  2022-12-14
  • 刊出日期:  2023-01-30

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