闭塞性结肠炎6例病例报告及文献回顾

发布时间：2018-10-19 20:43

【摘要】：背景与目的：闭塞性结肠炎(Obstructive Colitis)是指出现于结直肠完全或不完全狭窄性病变(大多为结直肠恶性肿瘤)口侧的缺血性病变,是一种特殊类型的缺血性肠病。本病发病率较低,但若在结直肠肿瘤手术前或手术中未仔细检查肿瘤病灶口侧的肠道粘膜,在缺血肠段进行缝合,则可能会引起肠瘘等术后并发症。闭塞性结肠炎这一概念尚未得到我国临床医生的认识与重视,本文拟通过病例报告及文献回顾对本病做一介绍。方法：回顾性分析2011年1月-2015年6月期间入住东南大学附属中大医院患者的结直肠镜检查结果,筛选出存在结直肠恶性肿瘤相关性闭塞性结肠炎患者,对其病例资料进行分析,并结合文献对本病进行全面复习。本次研究中闭塞性结肠炎的诊断标准为：内镜下结直肠恶性肿瘤口侧粘膜出现缺血性病变,肿瘤与缺血性病变之间存在长约2-6 cm完全正常的肠道粘膜,且肿瘤肛侧粘膜肉眼上无明显异常。结果：内镜及活检病理结果明确诊断为结直肠恶性肿瘤的患者共463例,其中6例被拟诊为结直肠恶性肿瘤相关性闭塞性结肠炎,发病率为1.3%。6例患者年龄均大于50岁,其中5例为男性,1例为女性,主要症状为腹痛、腹泻、便血。结肠镜下均表现为左侧结肠或直肠的肿瘤性病变(活检病理示6例均为结直肠中分化腺癌),内镜下同时发现肿瘤口侧的结肠粘膜可见缺血性病变(充血、水肿、纵行或环形溃疡),肿瘤与缺血性病变之间可见长约2-6cm的正常粘膜。5例患者进行了手术治疗,肿瘤病灶及缺血肠段均被切除,围手术期及术后随访期间未出现肠瘘及肠梗阻等并发症。1例患者明确诊断为结直肠恶性肿瘤后自动出院,失访。结论：闭塞性结肠炎为一种特殊类型的缺血性肠病,多继发于结直肠恶性肿瘤。结肠镜及活检病理检查是该病的确诊手段,提高对该病的认识,尽可能在术前或术中做出诊断,避免在缺血肠段进行缝合,会有助于减少肠瘘、腹膜炎等手术并发症,提高患者术后生存质量。
[Abstract]:Background & objective: (Obstructive Colitis) is a special type of ischemic bowel disease which occurs in the oral side of colorectal complete or incomplete stenosis (mostly colorectal malignant tumor). The incidence of this disease is relatively low, but if the intestinal mucosa of the Kitchen side of the tumor is not carefully examined before or during the operation, and the intestinal ischemia segment is sutured, it may cause postoperative complications such as intestinal fistula. The concept of obliterate colitis has not been recognized and paid much attention by Chinese clinicians. This article introduces the disease by case report and literature review. Methods: from January 2011 to June 2015, the results of colonoscopy of patients admitted to the affiliated Chinese University Hospital of Southeast University were retrospectively analyzed, and the patients with colorectal malignant tumor-associated obliterate colitis were screened out, and the data of the cases were analyzed. Combined with the literature review of the disease. In this study, the diagnostic criteria of obliterate colitis were as follows: there were ischemic lesions in the oral mucosa of colorectal malignant tumors under endoscope, and there was a completely normal intestinal mucosa with a length of 2 to 6 cm between the tumor and the ischemic lesion. There was no obvious abnormality in the anal mucosa of the tumor. Results: there were 463 cases of colorectal malignant tumor diagnosed by endoscopy and biopsy, 6 of them were diagnosed as colorectal malignant tumor-associated obliterative colitis, the incidence rate was 1.3.6 cases, all of them were over 50 years old. Among them, 5 cases were male and 1 case female. The main symptoms were abdominal pain, diarrhea and bloody stool. Under colonoscopy, tumor lesions were found in the left colon or rectum (biopsy and pathology showed that all 6 cases were middle differentiated adenocarcinoma of the rectum), and ischemic lesions (hyperemia, edema) were also found in the mucous membrane of the colon on the oral side of the tumor under endoscopy. Longitudinal or circular ulcers), the normal mucous membrane with long 2-6cm was seen between tumor and ischemic lesion. 5 patients were treated surgically. The tumor focus and ischemic intestinal segment were excised. There were no complications such as intestinal fistula and intestinal obstruction during perioperative period and postoperative follow-up. Conclusion: obliterated colitis is a special type of ischemic bowel disease, which is secondary to colorectal malignant tumor. Colonoscopy and biopsy and pathological examination are the means of diagnosis of the disease. To improve the understanding of the disease, to make the diagnosis before or during the operation as far as possible and to avoid suture in the ischemic intestinal segment will help to reduce the complications such as intestinal fistula, peritonitis and other surgical complications. To improve the quality of life after operation.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R574.62

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