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目的探讨原发性肠淋巴瘤(primary intestinal lymphoma,PIL)的临床特点、误诊原因及其防范措施。方法回顾性分析我院收治的曾误诊为Crohn病的PIL 1例的临床资料。结果本例因右下腹疼痛1年,反复发热8月余,加重2周入院。曾在我院就诊,经肠镜及病理检查等诊断Crohn病,给予美沙拉秦肠溶片及醋酸泼尼松龙等治疗,病情曾一度缓解,后又出现相应症状并加重2次入我院,行肠镜等检查仍提示Crohn病,再次给予美沙拉秦肠溶片及醋酸泼尼松龙等治疗,效果不佳,遂转入上级医院。经病理检查和免疫组织化学检查确诊PIL,给予抗肿瘤治疗2个疗程,患者体温降至正常,腹痛消失。结论 PIL临床少见,早期表现与Crohn病相似,易混淆。提高对其认识,发散诊断思维,多次、多部位取材进行病理检查和免疫组织化学检查及综合、全面、系统对病情进行分析可减少或避免其误诊误治。
Objective To investigate the clinical features, causes of misdiagnosis and preventive measures of primary intestinal lymphoma (PIL). Methods The clinical data of one case of PIL who had been misdiagnosed as Crohn disease admitted to our hospital were analyzed retrospectively. The results of this case of right lower quadrant pain for 1 year, repeated fever more than 8 months, increased 2 weeks admission. Had seen in our hospital, colonoscopy and pathological examination and other diagnosis of Crohn disease, given Mesalazine enteric-coated tablets and prednisolone acetate treatment, the condition was once relieved, and then the corresponding symptoms and increased 2 times into our hospital , Colonoscopy and other tests are still prompted Crohn disease, once again given Mesalazine enteric-coated tablets and prednisolone acetate treatment, the effect is not good, then transferred to the higher hospital. PIL was confirmed by pathological examination and immunohistochemical examination. Anti-tumor therapy was given for 2 courses. The patient’s temperature dropped to normal and abdominal pain disappeared. Conclusion The clinical manifestations of PIL are rare and their early manifestations are similar to those of Crohn’s disease and confusing. Improve their understanding, divergent diagnostic thinking, many times, multiple parts drawn for pathological examination and immunohistochemistry and comprehensive, comprehensive, systematic analysis of the disease can reduce or avoid misdiagnosis and mistreatment.