特发性肠系膜静脉硬化性肠炎临床特点分析  

Clinical characteristics of idiopathic mesenteric phlebosclerosis

作　　者：刘晓[1] 韦雨策 王薇[1] 傅亮[1] 罗庆锋[1] Liu Xiao;Wei Yuce;Wang Wei;Fu Liang;Luo Qingfeng(Department of Gastroenterology>Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Medical Oncology,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,National Cancer Center,National Clinical Research Center for Cancer,Beijing 100021.China)

机构地区：[1]北京医院消化内科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院内科,100021

出　　处：《中华老年医学杂志》2022年第2期179-184,共6页Chinese Journal of Geriatrics

摘　　要：目的分析总结特发性肠系膜静脉硬化性肠炎的临床表现、影像学及结肠镜检查特征、治疗及转归等,旨在加强临床医生对该疾病的认识。方法报道1例北京医院消化科收治的特发性肠系膜静脉硬化性肠炎患者,该患者因腹痛腹胀、停止排便排气3个月,再发伴呕吐2 d入院,结合患者病史、症状、体征、影像学及肠镜结果等,考虑患者不完全性肠梗阻病因为特发性肠系膜静脉硬化性肠炎;同时收集截至2021年4月国内外报道的特发性肠系膜静脉硬化性肠炎病例资料及相关文献,对该疾病的流行病学特征、发病机制、临床表现、诊断、治疗及预后等信息进行总结分析。结果联同本例复习截至2021年4月文献报道特发性肠系膜静脉硬化性肠炎病例共计206例,男女比例约2.75:1;111例个案报道明确提及患者年龄,中位年龄59岁,≥65岁老年患者36例(32.4%);常见临床表现包括腹痛、腹胀、腹泻、便血、恶心呕吐、停止排便排气等;病变好发部位包括盲肠、升结肠、横结肠等在内的右半结肠,其中以升结肠最易受累;影像学特征包括受累肠壁及邻近肠系膜血管线状、锯齿状或迂曲钙化,肠壁水肿增厚,肠周淋巴结反应性增生等;内镜下特征包括病变肠段黏膜水肿增厚、黏膜呈蓝紫色或青铜色改变、静脉迂曲扩张等;并发症包括肠梗阻、肠穿孔、肠坏死等;多数患者停服中药并经改善肠道微循环、抗炎、抗凝、抗感染等保守治疗措施后症状好转,疾病整体预后良好。结论特发性肠系膜静脉硬化性肠炎是一种非阻塞、非血栓、非炎症性肠系膜静脉硬化所致的肠道缺血,该疾病发病机制尚不明确,综合典型临床表现、特征性影像学、内镜及病理组织学检查结果有助于明确诊断。Objective To analyze and summarize the clinical manifestations,imaging and colonoscopy characteristics,treatment and prognosis of idiopathic mesenteric phlebosclerosis(IMP),so as to raise clinicians'awareness of this rare disease.Methods One case of IMP admitted into the Department of Gastroenterology,Beijing Hospital,was reported.The patient was admitted primarily due to abdominal pain,distension,and obstructed defecation and flatulence for 3 months,and recurrent vomiting for 2 days.Combining the patient's medical history,symptoms,physical signs,imaging and colonoscopy results,IMP was suspected to be the most likely cause for incomplete intestinal obstruction in this case.The literatures on IMP published before April 2021,including case reports,reviews and articles,were collected and analyzed.Based upon information mentioned above,the epidemiological characteristics,pathogenesis,clinical manifestations,diagnosis,treatment and prognosis of IMP were systematically reviewed,Results A total of 206 cases of idiopathic mesenteric vein sclerosing enteritis had been reported up to April 2021 in the literature,with a male to female ratio of about 2.75:1.Age was clearly mentioned in 111 case reports,with a median age of 59 years and 36 patients(32.4%)N65 years old.Common clinical manifestations include abdominal pain,distension,diarrhea,hematochezia,nausea and vomiting,obstructed defecation and flatulence,among others.The lesion is usually at the right side of the colon,including the cecum,ascending colon and transverse colon,with the ascending colon as the most commonly involved site.Imaging characteristics include linear,serrated or tortuous calcification of vessels inside the involved colon segments and adjacent mesenterium,edema and thickening of the intestinal wall,and reactive hyperplasia of lymph nodes.etc.Endoscopic features include edema and thickening of the intestinal wall,discoloration of the mucosa,and tortuous and dilated submucosal vessels.Complications include intestinal obstruction,perforation and necrosi

关 键 词：特发性肠系膜静脉硬化性肠炎 肠梗阻 结肠炎 缺血性 

分 类 号：R574[医药卫生—消化系统]