缺血性结肠炎27例临床分析及文献复习  

Clinical analysis of 27 cases with ischemic colitis and literature review

作　　者：谢宁[1] 代军 欧阳春晖[1] 汪春莲[1] 卢放根[1] 

机构地区：[1]中南大学湘雅二医院消化内科,湖南长沙410011 [2]湖南省常德市第一中医院消化内科,湖南常德415000

出　　处：《中国内镜杂志》2011年第10期1047-1052,共6页China Journal of Endoscopy

摘　　要：目的总结缺血性结肠炎(IC)的临床表现及内镜特点,探讨其早期诊断方法,以减少该病的误诊和漏诊。方法收集27例缺血性结肠炎患者的相关临床资料,所有病例均在症状出现后近期内行结肠镜及病理检查,并于首次检查后2、3周内复查结肠镜,部分病例在病变肠段再次病检,分析其临床表现及内镜下特点、病理改变。结果本病多发生于50岁以上的中老年人,且大多数伴有可能相关的基础疾病,包括心脑血管疾病、糖尿病、肝硬化及腹部手术史等,临床主要表现为腹痛、便血及腹泻、腹胀等。内镜下突出特点是病变呈节段性分布,病变部位与正常黏膜分界清楚,表现为黏膜充血、水肿、出血、糜烂及溃疡,病理改变非特异性。B超可见肠壁增厚,彩色多普勒可直接显示肠系膜血管的情况、血流量。结论对伴基础疾病或存在诱因的中老年患者,剧烈左下腹痛及便血时应警惕缺血性结肠炎,早期和动态的结肠镜检查以及彩色多普勒、钡剂结肠造影、腹部CT等是比较可靠的辅助诊断方法。IC病情预后与患者的年龄、伴随疾病、病变程度及是否早期诊治密切相关。【Objective】To summarize the clinical manifestations and endoscopic characteristics of ischemic colitis and investigate methods for its early diagnosis. 【Methods】Clinical data of 27 patients with ischemic colitis were collected. All cases received colonoscopy and pathological examination after the onset of their symptoms, and in 2 or 3 weeks received another colonoscopy examination after the initial inspection. The clinical manifestations, endoscopic characteristics and pathological features were analyzed.【Results】Ischemic colitis mostly occured in the elderly aged over 50, and may be likely associated with related diseases such as cardiovascular and cerebrovascular diseases, diabetes, cirrhosis of the liver and intestinal surgery. The main clinical manifestations were abdominal pain, bloody stool and diarrhea. Prominent endoscopic characteristics of ischemic colitis were as follows： the lesions distributed segmentaly, had clear boundaries with the normal mucosa, manifested by mucosal hyperemia, edema, hemorrhage, erosion and ulceration, the pathological changes were nonspecific. 【Conclusion】 Ischemic colitis should be alerted when elderly patients with related diseases or incentives suffer severe abdominal pain and bloody stool. Early and dynamic colonoscopy combined with color Doppler, barium colonography or abdominal CT are reliable auxiliary diagnostic methods. Prognosis of ischemic colitis is closely related to age, accompanied diseases, the severity and whether the patients received early diagnosis and treatment.

关 键 词：缺血性结肠炎 临床表现 内镜特点 

分 类 号：R453[医药卫生—治疗学]