缺血性肠病的临床特点及诊疗分析

发布时间：2019-01-20 11:02

【摘要】：目的：分析本地区缺血性肠病的临床特点及诊疗情况，以提高对缺血性肠病的认识，明确诊断，，减少误诊率。方法：收集2010年10月至2013年10月福建医科大学附属第一医院消化内科收治的66例缺血性肠病患者的临床资料，回顾性分析其临床表现、实验室检查、影像学检查、结肠镜检查及治疗经过。结果：1、66例缺血性肠病患者中缺血性结肠炎占36例（54.5%），急性肠系膜缺血次之；男女比例大致为1:1；＞60岁占74.2%；其中有59例合并基础病，高血压病68.2%，动脉硬化47.0%，还包括2型糖尿病、冠心病、高脂血症、心房颤动、脑梗塞等疾病。2、临床症状包括腹痛（93.9%）、血便（43.9%）、腹胀、便秘、腹泻、消瘦等，其中以左腹痛（29.0%）最常见。90.6%腹部仅轻压痛。3、56.7%粪便隐血阳性；50.0%D-二聚体检测值升高，部分白细胞计数升高、血红蛋白值降低、凝血酶原时间延长。4、31例患者完成螺旋CT血管造影，阳性率为61.3%，以肠系膜上动脉病变多见；而CT检查、磁共振、全腹彩超及腹部立位平片例数较少，阳性率在16.7%-45.8%之间。5、本组中81.8%患者行结肠镜检查，阳性率53.7%，以累及乙状结肠（82.8%）及降结肠和（或脾区）（51.7%）多见。有23例病理活检，其中17例见粘膜慢性炎症或炎性肉芽组织形成；仅少数示缺血性结肠炎改变及粘膜内色素沉着。6、66例病例均予一般治疗，且联合改善循环55例，扩张肠道血管43例，抗凝治疗33例，抗感染治疗15例。64例治疗有效，2例无效转外科手术治疗。结论：缺血性肠病多见于老年人，尤其是有高血压病和动脉硬化者，如果腹痛伴有粪便隐血、D-二聚体阳性时，应怀疑本病。内科治疗效果良好。
[Abstract]:Objective: to analyze the clinical features and diagnosis and treatment of ischemic bowel disease in order to improve the understanding of ischemic bowel disease and to reduce the misdiagnosis rate. Methods: from October 2010 to October 2013, 66 patients with ischemic bowel disease were collected from the Department of Digestive Medicine, the first affiliated Hospital of Fujian Medical University, and their clinical manifestations, laboratory and imaging findings were analyzed retrospectively. Colonoscopy and treatment. Results: 1Ischemic colitis was found in 36 (54.5%) of 66 patients with ischemic bowel disease, followed by acute mesenteric ischemia, the ratio of male and female was about 1: 1, > 60 years old accounted for 74.2%. There were 59 cases of basic diseases, 68.2% hypertension, 47.0% arteriosclerosis, 2 type diabetes, coronary heart disease, hyperlipidemia, atrial fibrillation, cerebral infarction, etc. 2. Clinical symptoms included abdominal pain (93.9%). Blood stool (43.9%), abdominal distension, constipation, diarrhea, emaciation, etc. Left abdominal pain (29.0%) was the most common. The positive rate of spiral CT angiography was 61.3% in 41 patients with thrombin prothrombin, the positive rate was 61.3%, and the lesion of superior mesenteric artery was the most common. The positive rate of CT, magnetic resonance imaging, total abdominal color ultrasound and abdominal plain film was between 16.7- 45.8%. 81.8% of the patients underwent colonoscopy, and the positive rate was 53.7%. Sigmoid colon (82.8%), descending colon (51.7%) and descending colon (51.7%) were involved. There were 23 cases of pathological biopsy, of which 17 cases showed chronic inflammation of mucosa or inflammatory granulation tissue formation. Only a few cases showed changes of ischemic colitis and intramucosal pigmentation. 66 cases were treated with general treatment, 55 cases with combined improvement of circulation, 43 cases with dilatation of intestinal vessels, 33 cases with anticoagulant therapy, 15 cases with anti-infection treatment and 64 cases with effective treatment. 2 cases were transferred to surgery. Conclusion: ischemic bowel disease is more common in the elderly, especially in patients with hypertension and arteriosclerosis. If abdominal pain is accompanied by fecal occult blood and D-dimer is positive, the disease should be suspected. The effect of internal medicine treatment is good.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574

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