初发型溃疡性结肠炎致中毒性巨结肠五例分析  

Toxic megacolon induced by primary ulcerative colitis

作　　者：陈超武[1] 黄忠诚[1] 成世盈[1] 唐枚徕[1] 肖志刚[1] 刘琪[1] 

机构地区：[1]湖南省人民医院结直肠肛门外科,长沙410005

出　　处：《中华普通外科杂志》2009年第7期547-549,共3页Chinese Journal of General Surgery

摘　　要：目的探讨初发型溃疡性结肠炎致中毒性巨结肠的临床表现及诊治方法。方法回顾性分析2003年6月至2008年10月收治的5例初发型UC致中毒性巨结肠患者的临床资料。结果5例患者首发症状均为腹痛、腹胀，因口服泻剂而诱发中毒性巨结肠，2例发生肠穿孔。4例女性患者出现神志异常，4例行磁共振检查，3例示腔隙性脑梗塞。该5例患者均接受手术探查，且在术前均未确立溃疡性结肠炎的诊断。5例均行部分结肠切除及肠造口术，平均手术2．4次。术后死亡1例。吻合口瘘1例，吻合口狭窄1例。结论腹痛、腹胀及服用导泻剂后临床症状加重是初发型溃疡性结肠炎致中毒性巨结肠常见的临床表现。Objective To analyze the clinical manifestations and treatment for toxic megacolon induced by drastic cathartics inpatients with an unknown history of ulcerative colitis. Methods The clinical data of 5 patients with toxic megacolon induced by ulcerative colitis with initial onset type from June 2003 to October 2008 were analyzed retrospectively. Results In 5 cases, the first symptom was abdominal pain and distention. After taking cathartics, these 5 cases were complicated with toxic megacolon and 2 cases suffering from intestinal perforation. Four female patients suffered from transient unconsciousness, in which 3 patients were found with cerebral lacunal infarction identified by magnetic field diffusion-weighted imaging. All 5 cases underwent exploration, colectomy and ostomy, one patient died perioperatively, anastomotic fistula and anastomotic constriction developed in one each cases. Conclusions The most common clinical manifestations of toxic megacolon induced by ulcerative colitis are abdominalgia, abdominal distention. Emergency therapeutic strategy consists of partial eolectomy and ostomy.

关 键 词：结肠炎 溃疡性 巨结肠 中毒性 外科手术 

分 类 号：R686[医药卫生—骨科学]