潰瘍性結(jié)腸炎的診斷與治療

1、Endoscopic features of active ulcerative colitisFigure 4-1. Endoscopic features of active ulcerative colitis. Findings include diffusely erythematous, edematous, and granular mucosa with areas of submucosal hemorrhage and, when severe, frank mucopurulent exudate. Inflammation invariably begins in th

2、e rectum and extends proximally for varying extents. The chronicity of the process is suggested by the loss of colonic haustrations; otherwise, the endoscopic picture is nonspecific and could be consistent with acute infectious colitis, chronic ulcerative or Crohns colitis, or any number of other sp

3、ecific causes of colitis. A, Mild distal ulcerative colitis with diffuse erythema and friability well demarcated from the normal mucosa more proximally is depicted. B, This example shows moderately severe ulcerative colitis with irregular, inflamed, ulcerated mucosa and a patchy exudate.Ulcerative c

4、olitis in remissionFigure 4-2. Ulcerative colitis in remission. The normal vascular pattern is absent and a white scar indicates the site of a previous ulcer.Severe ulcerative colitisFigure 4-3. Severe ulcerative colitis. The mucosa shows extensive ulceration and diffuse thickening with an inflammat

5、ory infiltrate. In contrast to Crohns colitis, the ulceration lacks depth.Chronic ulcerative colitisFigure 4-5. Chronic ulcerative colitis. In long-standing ulcerative colitis, the mucosa has an atrophic and scarred appearance with a blunted vascular pattern. Pseudopolyps are often present.Severe ul

6、cerative colitis with pseudopolypsFigure 4-4. Severe ulcerative colitis with pseudopolyps. In addition to severe mucosal ulceration and inflammation, chronic ulcerative colitis is often associated with the formation of pseudopolyps, which represent islands of regenerating mucosa and exuberant inflam

7、mation amidst diffuse mucosal destruction. Pseudopolyps have no malignant potential.Severe ulcerative colitisFigure 4-6. Radiographic appearance of severe ulcerative colitis. This single-contrast barium enema demonstrates the typical ragged and ulcerative appearance of the mucosa in active ulcerativ

8、e colitis. Characteristic collar-button or undermining ulcers are seen. In general, barium enema and colonoscopy should be avoided in fulminant ulcerative colitis because of the possibility of precipitating toxic megacolon.Chronic ulcerative colitisFigure 4-7. Radiographic appearance of chronic ulce

9、rative colitis. Long-standing chronic ulcerative colitis, as shown in this single-contrast barium enema, is characterized by shortening and straightening of the colon with loss of haustrations, resulting in the appearance of a featureless tube. No ulcerations are seen.鑒別要點鑒別要點UCCD病變連續(xù)性病變連續(xù)性 +穿壁性累及穿壁

10、性累及 +/+集合淋巴小結(jié)集合淋巴小結(jié) +隱窩膿腫隱窩膿腫 +肉芽腫結(jié)節(jié)肉芽腫結(jié)節(jié) +竇道竇道/瘺管瘺管 +直腸病變直腸病變 +/口瘡樣潰瘍或線性潰瘍口瘡樣潰瘍或線性潰瘍+鋪路石樣改變鋪路石樣改變 +粘膜脆性粘膜脆性 +粘膜脆性+UC和和CD的病理鑒別要點的病理鑒別要點+ 始終有始終有 +常有常有 +偶有偶有 無無指標指標輕癥輕癥重癥重癥暴發(fā)暴發(fā)1、大便（次數(shù)、大便（次數(shù)/天）天）102、大便中帶血、大便中帶血間歇性間歇性經(jīng)常經(jīng)常持續(xù)持續(xù)3、體溫、體溫(C)正常正常37.537.54、脈搏、脈搏(次次/分分)90905、血紅蛋白、血紅蛋白正常正常30307、結(jié)腸放射學、結(jié)腸放射學表現(xiàn)表現(xiàn)無無充

11、氣充氣,腸壁水腸壁水腫腫擴張擴張8、體征、體征無無腹部壓痛腹部壓痛腹部脹滿、腹部脹滿、壓痛壓痛評估潰瘍性結(jié)腸炎嚴重性的評估潰瘍性結(jié)腸炎嚴重性的標準標準 輕度潰結(jié)的處理輕度潰結(jié)的處理可選用柳氮磺胺吡啶（可選用柳氮磺胺吡啶（SASPSASP）制劑，每）制劑，每日日34g34g，p op o；5- 5-氨基水楊酸（氨基水楊酸（5-ASA5-ASA）制）制劑。遠段結(jié)腸者可劑。遠段結(jié)腸者可SASPSASP栓劑栓劑0.51g0.51g，每日，每日2 2次；氫化可的松琥珀酸鈉鹽灌腸液次；氫化可的松琥珀酸鈉鹽灌腸液100200mg100200mg，每晚，每晚1 1次保留灌腸，或用相次保留灌腸，或用相當劑量的當

12、劑量的5-ASA5-ASA制劑灌腸制劑灌腸，亦可用中藥保留灌腸治療。* 包括巨紅細胞癥、變性血紅蛋白及Heing抗體水平升高。* 有紅細胞G-6-PD缺乏患者，同樣可發(fā)生溶血。SASP的不良反應的不良反應UCCD中度或重度發(fā)作，對中度或重度發(fā)作，對SASP治治療無滿意反應療無滿意反應發(fā)熱、心動過速、體重下降或發(fā)熱、心動過速、體重下降或疾病其他活動的證據(jù)疾病其他活動的證據(jù)嚴重發(fā)作，如高熱、心動過速、嚴重發(fā)作，如高熱、心動過速、直腸頻繁大量出血、結(jié)腸直腸頻繁大量出血、結(jié)腸擴張、水、電解質(zhì)紊亂及擴張、水、電解質(zhì)紊亂及貧血等貧血等貧血、血沉加快、吸收不良、貧血、血沉加快、吸收不良、小腸或結(jié)腸廣泛病變、慢性小腸或結(jié)腸廣泛病變、慢性腹瀉和腹部痙攣性疼痛腹瀉和腹部痙攣性疼痛全結(jié)腸炎全結(jié)腸炎全身表現(xiàn)（關節(jié)炎、葡萄膜炎、全身表現(xiàn)（關節(jié)炎、葡萄膜炎、肝臟病變）肝臟病變）暴發(fā)性結(jié)腸炎暴發(fā)性結(jié)腸炎/或中毒性巨結(jié)或中毒性巨結(jié)腸癥腸癥腸切除術(shù)后疾病復發(fā)腸切除術(shù)后疾病復發(fā)結(jié)腸外的全身表現(xiàn)結(jié)