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1、,内镜复查对IBD临床处理的诊断价值,上海交通大学医学院附属新华医院 吴建新,Significance of Follow-up with Endoscope for Management of IBD,,Company Logo,My Talk Can Begin with,普通内镜（white light endoscopy, WLE） 色素内镜（Chromoendoscpy） 虚拟色素（NBI, I-Scan, FICE） 超声内镜（endoscpic ultrasonography, EUS） 共焦内镜（confocal laser endomicroscpoy, CLE）,,Comp
2、any Logo,Or, with,1. Challenge: Incidence & Prevalenc-Endoscopic Diagnosis 2. Distinguishing IBD From Other Disorders, UC and CD 3. Assessment of Extent and Severity 4. Assessment of Response and Prediction of Relapse 5. Surveillance: Dysplasia and Colorectal Cancer,,Company Logo,The Earliest Report
3、 of symptom,Reports of manifestations of IBD (Crohns Disease?) have been reported as early as 850 AD when King Alfred, “Englands Darling“, suffered from an illness which caused pain on eating, discomfort, and much embarrassment. This affliction plagued the King from the age of 20, without remission.
4、 At the time the illness was thought to be due to witchcraft, or a punishment for the Kings infidelities. In retrospect, however, the illness was probably Crohns Disease from todays knowledge.,,Company Logo,The Earliest Medical Article,An article was published in the British Medical Journal of 1913
5、by T. Kennedy Dalziel, who reported treating 13 patients who had suffered from intestinal obstruction. On autopsy he found that all 13 patients had inflamed gut, especially in the jejunal, ileal and colonic areas. On examining the inflamed bowel more closely, the transmural inflammation that is char
6、acteristic of the disease was clearly seen.,IBD:,From: Inflam Bowel Dis 2009: 1232,(a),(b),(b),,Company Logo,UC 176篇 3053例,CD 356篇 3703例,1989-2008年 （文献572篇）,我国医学文献报道的IBD病例数,“万方期刊库”,“中国期刊网”,“中国科技期刊数据库”,“中国生物学文摘数据库”等,,Company Logo,我国医学文献报道的IBD病例数,1989-2008我国医学文献报道的溃疡性结肠炎病例数,,Company Logo,我国医学文献报道的IBD病
7、例数,1989-2008我国医学文献报道的克罗恩病例数,,Company Logo,中文文献IBD 误诊数据与类别,误诊定义与分类A类误诊入院诊断其它病并已治疗，出院诊断IBD，或称“漏诊”B类误诊入院诊断IBD并已治疗，出院诊断其它病，或称“错诊”,,（1989-2008年，572篇）,,Company Logo,中文文献炎症性肠病的误诊分类统计,UC （3053例） A 类 912例（29.9%） B 类 221例（ 7.2%） 总计 1133例（37.1%）,CD （3073例）A 类 1801例（48.6%）B 类 627例（16.9%）总计 1828例（76.5%）,,来自1989-
8、2008中文期刊572篇文献（UC176篇 CD 356篇）,,Company Logo,溃疡性结肠炎误诊病种统计-A类,来自1989-2008我国176篇UC相关医学文献报道,,Company Logo,溃疡性结肠炎误诊病种统计-B类,来自1989-2008我国176篇UC相关医学文献报道,,Company Logo,来自1989-2008我国356篇CD相关医学文献报道,克罗恩病误诊病种统计-A类,,Company Logo,来自1989-2008我国356篇CD相关医学文献报道,克罗恩病误诊病种统计-B类,,Company Logo,中文文献炎症性肠病的误诊分类统计,UC （3053例）
9、 A 类 912例（29.9%） B 类 221例（ 7.2%） 总计 1133例（37.1%）,CD （3073例）A 类 1801例（48.6%）B 类 627例（16.9%）总计 1828例（76.5%）,,来自1989-2008中文期刊572篇文献（UC176篇 CD 356篇）,,Company Logo,挑战诊治IBD的消化专科医师的问题,你们医院内镜检查有会诊制度吗 ？您是否亲自您的患者作内镜检查 ？您肠镜检查时是否常规插入会肠 ？肠粘膜损伤患者您如何进行活检 ？您是否经常与病理医师读片讨论 ？您怎样对您的患者进行内镜随访 ？,,Company Logo,挑战诊治IBD的消化专科
10、医师的问题,确定诊断IBD的“金”标准内镜图像特征性肠粘膜损害病理依据特征性组织学描述,,Company Logo,内镜检查和活检病理的目的,确定IBD的诊断、确定CD或UC 提供粘膜损害的严重程度依据 活动指数 提供评估病变的范围（UC; CD?） 追踪和判断治疗效果，指导修改治疗方案 提供梗阻、癌变的形态学依据,（2006）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（Journal of Crohn and Colitis）,（2006）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（2006）
11、,（Journal of Crohn and Colitis）,（2010;4:7-27）,（2006）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（Journal of Crohn and Colitis）,（2010;4:7-27）,（2006）,（Journal of Cro
12、hn and Colitis）,（2010;4:7-27）,Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology,（J Clin Pathol 1997;50:93-105）,Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel
13、disease. The British Society of Gastroenterology,Guidelines for the initial biopsy diagnosis of suspected chronic idiopathic inflammatory bowel disease. The British Society of Gastroenterology,,Company Logo,ECCO Statement 3F (2010),Focal (discontinuous) chronic (lymphocytes and plasma cells) inflamm
14、ation and patchy chronic inflammation, focal crypt irregularity (discontinuous crypt distortion), and granulomas (not related to crypt injury) are the generally accepted microscopic features that permit a diagnosis of CD EL2, RGB. The same features and, in addition, an irregular villous architecture
15、, can be used for analysis of endoscopic biopsy samples from the ileum. If the ileitis is in continuity with colitis, the diagnostic value of this feature should be used with caution EL2, RG B.,Travis SM, er al. Gut 2010 gt81950A 10/01/06,,Company Logo,2010年ECCO关于CD病理特征的声明,与会专家一致认为，CD 的特征性病理组织学特征有：局灶性（focal or discontinuous）慢性炎症（非连续性、粘膜浸润以淋巴细胞和浆细为主）和斑片状慢性炎症（patchy chronic inflammation）、局灶性隐窝不规则（非连续性隐窝不规则）和肉芽肿（与隐窝损害无关）等 EL5, RG D。内镜下回肠活检标本病理特征除此以外，绒毛结构不规则也作为诊断参考依据。如出现回肠炎症与结肠炎症连续一起时，上述标准应用时需慎重EL2, RG B,
