老年人缺血性结肠炎的诊治

目的 探讨老年人缺血性结肠炎(IC)的临床特点,提高诊治水平.方法 采用回顾性病例分析的方法,收集12例IC患者的临床症状、体征、相关的基础疾病、内镜表现、病理、化验、影像学资料及转归,并进行分析.结果 12例患者男女之比为1∶3,均为一过型IC,伴有相关的基础疾病者11例(91.7%),临床表现均有不同程度的腹痛(100%),腹痛后便血(100%),多数伴有恶心、呕吐、腹泻.结肠镜检查示,病变部位以左半结肠为主(91.7%),表现为黏膜纵行充血、水肿、糜烂,黏膜下出血,病变黏膜与正常黏膜分界清楚.血浆D-二聚体检测以及影像学检查无异常表现.结论 有相关基础疾病的老年患者出现腹痛、便血、胃肠道排空症状时,提示IC可能,早期结肠镜检查是确诊IC的首选方法,血浆D-二聚体检测以及腹部CT检查具有重要的阴性价值.

Diagnosis and treatment of ischemic colitis in elderly patients

Objective To explore the clinical features of ischemic colitis (IC) in elderly patients for improving diagnosis and treatment. Methods The clinical symptoms, physical signs,underlying diseases, colonoscopic features, pathology features, laboratory examination and medical imageology data and prognosis were analyzed retrospectively in 12 patients with IC. Results (91.7%) had underlying diseases. They all had different degrees of abdominal pain, and experienced bloody stools after abdominal pain. Majority of them showed symptoms of nausea, vomiting and diarrhea. Colonoscopy showed that the most common lesions were located in the left colon (91.7%).Endoscopic appearances were edema, congestion and erosion of mucous membrane in colon,submucosal bleeding as well, and the lesion was longitudinal and demarcated with normal areas. The detection of plasma D-dimer and the imageology in all patients were normal. Conclusions IC should be suspected in elderly patients who have related underlying diseases accompanied by acute abdominal pain, hematochezia and gastric emptying symptoms. The early endoscopy is the first choice in the diagnosis of IC. Abdominal CT scan as well as the detection of plasma D-dimer have an important negative predictive value for IC.