85例缺血性结肠炎患者内镜表现及病理特点分析  

Endoscopic findings and clinicopathologic characteristics of eighty five patients with ischemic colitis

作　　者：姚玉玲[1] 曹俊[1] 刘文佳[1] 陈隆典[1] 邹晓平[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化科,210008

出　　处：《中华消化杂志》2010年第3期158-161,共4页Chinese Journal of Digestion

摘　　要：目的探讨缺血性结肠炎（IC）的内镜表现和病理特征．以引起临床医师对该痫的重视，减少漏诊和误诊。方法对南京大学医学院附属鼓楼医院内镜中心2005年5月至2008年3月85例IC患者进行回顾性分析。所有患者均在发病2周内行结肠镜检查和病理活检。结果85例IC患者临床主要表现为腹痛、腹泻和便血、可伴有低热等。结肠镜下所见病变主要住左半结肠（80％，68／85）。85例Ic患者中非坏疽型82例和坏疽型3例。非坏疽型中一过性1C内镜表现为点状出血，黏膜水肿、发脆，节段性红斑，散在糜烂和纵行溃疡．病变与正常黏膜分界清楚。非可逆性IC内镜表现为黏膜发紫或发黑、伪性、假息肉及假性肿瘤．其中狭窄性IC内镜表现为全孽增厚、肠腔狭窄及结肠袋消失。坏疽型IC内镜表现为黏膜发紫和假息肉肜成。Ic病理特征为黏膜组织炎症伴糜烂和肉芽组织增生、腺体萎缩、固有层出血，特别是黏膜下层见含铁血黄素沉着的巨噬细胞。结论尽管IC内镜及病理改变缺乏特异性．但早期行结肠镜检是诊断Ic的重要方法．有助于临床医师提高对IC的诊治，减少误诊。Objective To evaluate the endoscopic findings and clinicopathologic characteristics of ischemic colitis in order to avoid misdiagnosis. Methods Eighty five patients with ischemic colitis who underwent endosopy within two weeks of onset of the symptom in center of Gulou hospital from Mar. 2005 to Apr. 2008 were retrospectively reviewed for their endoscopic findings and clinicopathulogic characteristics. All biopsy specimens were pathologically examined with HE and observed under light microscopy. Results The common features of 85 patients included abdominal pain, diarrhea or hloody diarrhea and hematochezia. The lesions were mainly located at left colon with segmental form（80 ＇i. 68/85）. Of 85 patients, non-gangraenous type was found in 82 and gangrenous type in3 . Endoscopic visualization of transient ischemic colitis included petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement . Stricture ischemic colitis was characterized by full-thickness mucosa, lumens stricture and haustrations disappeared. The characteristics of gangrenous colitis was cyanotic and pseudopolyps. Clinicoplathological examination revealed mucosal inflammation accompanied by erosion, granulation tissue hyperplasia and gland atrophy, lamina propria hemorrhage, especially macrophages with hemosiderin pigmentation in submucosa. Conclusions Although there is no specific changes in endoscopic findings and clinicopathologic characteristics, but early colonoscopy plays an important role in diagnosis of ischemic colitis, which is helpfull in management of ischemie colitis and reducing the misdiagnosis.

关 键 词：缺血性肠炎 内镜检查 病理学 

分 类 号：R574.62[医药卫生—消化系统]