缺血性结肠炎的临床病理特征、内镜诊治及转归

目的：分析缺血性结肠炎（IC）的临床特征、诊断时的内镜与组织学特点治疗及转归。方法：回顾性分析2002年4月—2010年11月间诊治的64例缺血结肠炎患者的临床资料。分析指标包括：年龄、性别、组织学特征、发病的危险因素、内镜特点、治疗及预后。结果：64例患者平均年龄62.5±5.2岁,男性（30例）与女性（34例）发病率在无显著差异。最常见的临床表现是腹痛（94.5%）、便血（92.1%）和腹泻（73.4%）。早期内镜检查（n=63）发现结肠黏膜水肿及局部出血（100%）。组织学表现为肠壁的急性缺血坏死（100%）。52例患者同时存在1或多个基础疾病,多因素分析表明：同时伴发的高血压病（73.4%）、糖尿病（20.3%）和心房纤颤（17.1%）是发生IC的危险因素。绝大多数患者经过支持治疗在数天内临床状况改善而且预后良好,仅少数（1.6%）患者需行部分肠切除治疗。结论：缺血性结肠炎好发于中老年,最常见的症状是腹痛和便血;结肠镜联合活组织病理检查是安全、有效的早期确诊手段。同时伴发高血压病、糖尿病或心房纤颤是发生IC的危险因素。大多数患者经过对症支持治疗能在数天内恢复。

The Clinicopathological Features, Endoscopic Diagnosis, and Outcome of Ischemic Colitis

Objective：The aim of this study was to evaluate the clinical characteristics,endoscopic,and histological features of patients with ischemic colitis（IC）.Methods： The clinical data of 64 patients with IC who admitted to our hospital from April 2002 to November 2010 were analyzed retrospectively.Patients were diagnosed on the basis of endoscopic findings or surgical management.Results： A total of 64 patients were included,the average age was of 62.5±5.2 years.The most frequent symptoms were the abdominal pain（94.5%）,bloody stools（92.1%）,and diarrhea（73.4%）.The early endoscopy（n=63） showed edema and focal hemorrhage of mucosa（100%）,and colonoscopy was safe and helpful to confirm the diagnosis.The histological findings showed acute ischemic necrosis of the bowel wall in the whole population（100%）.Fifty-two patients had at least one co-existing medical diseases.The following variables were associated with IC in the univariate analysis： arterial hypertension（P = 0.036）,diabetes mellitus（P = 0.028）,and atrial fibrillation（P = 0.042）.The patients with mild or moderate IC had a better prognosis within several days with supportive care,only a few（1.6%） will require laparotomy with bowel resection.Conclusions： The IC is more frequent in the older age.The most frequent symptoms are the abdominal pain and bloody stools.Colonoscopy and histological studies are safe and helpful in the early diagnosis of IC.The development of IC is associated with arterial hypertension,diabetes,and atrial fibrillation.Most of patients improve within several days with supportive care.