缺血性结肠炎临床特点和内镜特征及转归分析

发布时间：2018-10-31 12:19

【摘要】：目的探讨缺血性结肠炎(IC)患者的临床特点、内镜特征及转归。方法选取2008年1月—2014年6月昆明医科大学附属延安医院消化内科收治的81例IC患者的临床资料,回顾性分析其临床表现、基础疾病、实验室检查、结肠镜检查、腹部CT检查结果及转归。结果 IC多发于中老年患者,多数合并有高脂血症、高血压、糖尿病或糖耐量异常以及动脉粥样硬化等基础疾病。主要临床表现为下腹痛,餐后加重,腹泻及便血。非坏疽型IC患者80例和坏疽型IC患者1例。非坏疽型IC结肠镜下常以黏膜充血、水肿、糜烂、纵型溃疡形成等改变为主要表现,病变严重者出现肠壁增厚、结肠袋消失及肠腔狭窄;坏疽型IC结肠镜下表现为黏膜广泛发紫及假性息肉形成,病变部位位于左半结肠,呈节段性分布,患者预后良好。疾病转归与病变部位、程度、有无并发症、伴随基础疾病情况有关。结论 IC的临床及结肠镜表现无明显特异性。临床上对于出现急性下腹痛及便血,既往有高脂血症、高血压、糖尿病以及动脉粥样硬化等疾病基础的患者应警惕IC可能,及早进行结肠镜检查,可明确诊断,有助于判断预后。治疗后第2次结肠镜检查对IC的诊断有着重要意义。
[Abstract]:Objective to investigate the clinical features, endoscopic features and outcome of ischemic colitis (IC). Methods from January 2008 to June 2014, the clinical data of 81 patients with IC in the Department of Gastroenterology, Yan'an Hospital affiliated to Kunming Medical University were retrospectively analyzed. The clinical manifestations, basic diseases, laboratory examination and colonoscopy were analyzed retrospectively. Abdominal CT examination results and outcome. Results most of IC were associated with hyperlipidemia, hypertension, diabetes mellitus or impaired glucose tolerance and atherosclerosis. The main clinical manifestations were lower abdominal pain, postprandial aggravation, diarrhea and hematochezia. There were 80 cases of non-gangrenous IC and 1 case of gangrenous IC. The changes of mucosal congestion, edema, erosion and longitudinal ulcers were the main manifestations under colonoscopy of non-gangrene IC. The thickening of intestinal wall, the disappearance of colonic bag and the stenosis of intestinal cavity were found in patients with severe lesions. Gangrenous IC colonoscopy showed extensive purplish mucosa and pseudo-polyps. The lesion was located in the left hemicolon with segmental distribution. The prognosis of the patients was good. The outcome of the disease is related to the location, degree, complication and underlying condition of the disease. Conclusion the clinical and colonoscopic manifestations of IC have no obvious specificity. Clinically, patients with acute lower abdominal pain and hematochezia, past hyperlipidemia, hypertension, diabetes and atherosclerosis should be on guard against the possibility of IC, and colonoscopy should be carried out as early as possible to make a definite diagnosis. It helps to judge the prognosis. The second colonoscopy after treatment is of great significance in the diagnosis of IC.
【作者单位】：昆明医科大学附属延安医院消化内科;
【分类号】：R574.62

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