大肠黑变病的临床及内镜特征分析

目的探讨大肠黑变病的临床特点、内镜表现、病理特征等。方法总结23 596例接受结肠镜检查的患者中发现大肠黑变病患者的病例资料,对患者的临床特点、内镜表现及病理特征等进行分析。结果共发现大肠黑变病715例,检出率3.03%,其中男性检出率2.86%,女性检出率3.17%,女性高于男性,差异有统计学意义(P0.05);其中老年组患者占67.1%,中青年组患者占32.9%,中年组明显高于青年组(P0.05);病变多累及1个或多个肠段,左半结肠和右半结肠发生率较高;193(27.0%)例伴有大肠腺瘤,68(9.51%)例伴有结肠癌;401(56.1%)例患者有便秘,358(50.1%)例有服用泻药史。结论大肠黑变病的发病率与文献报道基本一致,女性高于男性,病变多位于左半结肠和右半结肠;大肠黑变病与结肠腺瘤和结肠癌可能有相关性,其发病与便秘和服用蒽醌类泻药有关。     

中青年大肠黑变病的临床及内镜特征分析

目的探讨中青年大肠黑变病的临床特点、内镜表现、病理特征等。方法总结4978例接受结肠镜检查的患者中发现60岁以下中青年大肠黑变病患者的病例资料,对患者的临床特点、内镜表现及病理特征等进行分析。结果共发现中青年大肠黑变病61例,检出率1．23％,其中男性检出率1．32％,女性检出率1．16％,男性高于女性,差异有统计学意义（P〈0．05）,病程2个月～30年;其中中年组患者占70．5％,青年组患者占29．5％,中年组明显高于青年组（P〈0．05）;病变多累及1个或多个肠段,左半结肠和右半结肠发生率较高;15例伴有大肠腺瘤,2例伴有结肠癌;48例患者有便秘,37例有服用泻药史。结论中青年大肠黑变病的发病率与文献报道基本一致,男性高于女性,病变多位于左半结肠和右半结肠;大肠黑变病与结肠腺瘤和结肠癌可能有相关性,其发病与便秘和服用蒽醌类泻药有关。     

结肠黑变病的临床研究

目的 探讨结肠黑变病与大肠肿瘤是伴发还是因果关系及其转归。方法 1998-01／2001-12在2768例结肠镜检查中发现58例粘膜呈虎皮样改变，作粘膜活检后观察病理组织学上的表现。结果 58例经病理证实为结肠黑变病，其中60岁以上42例，40～60岁16例。随访32例中结肠黑变消失6例，好转19例，无改变7例。结论 结肠黑变病是一种以肠粘膜色素沉着为特征的疾病，便秘和长期服用泻药是发病原因之一，有息肉及癌变的发生倾向。良好的生活习惯和对症治疗可使结肠黑变逆向转归。     

结肠黑变病53例临床病理分析

结肠黑变病（melanosis coli，MC）是一种少见的非炎症性、良性、可逆性的，以色素沉着为特征的黏膜色素沉着性病变，结肠黏膜内有很多吞噬有脂褐素样物质的巨噬细胞，可通过结肠镜检查而诊断。2001年3月至今，我院在结肠镜检查中发现结肠黑变病53例，其中31例进行了病理组织学检查，现报告分析如下。     

大肠黑变病12例报告

大肠黑变病是一种少见的结肠粘膜色素沉着为特征的非炎症性良性可逆性疾病，笔者自1991—05／2001—04共行结肠镜检查10346例，检出大肠黑变病12例，并经病理组织学检查证实，现报告如下。     

结肠黑变病对结直肠息肉的影响

目的研究结肠黑变病对结肠息肉发生率、病理类型等的影响。 方法回顾性分析自2012年8月至2015年12月在我院经全结肠镜诊断的结肠黑变病98例,组成黑变病组;随机选取结肠镜诊断无结肠黑变病252例,组成非黑变病组。比较两组一般情况、结肠息肉发病率、息肉病理类型等。 结果结肠黑变病II度、III度累及全结肠的比例分别为71.0%、78.6%,高于黑变病I度的50.9%（P=0.01）。结肠黑变病组结肠息肉发现率达40.8%,远高于非结肠黑变病的23.0%（P=0.001）,而且黑变病组在横结肠、降结肠、盲肠及全结肠≥3个部位发现结肠息肉的比例均高于非黑变病组,P均<0.05,但两组息肉中腺瘤的比例分别为80%、67.9%（P=0.117）,差异无统计学意义。黑变病I、II、III度在息肉检出率、息肉病理类型的比较上,均P>0.05,差异无统计学意义。左半结肠为主型、右半结肠为主型、全结肠型黑变病在息肉检出率、息肉病理类型的比较上,也均P>0.05,差异无统计学意义。 结论结肠黑变病患者结肠息肉发生率高,需加强对结肠黑变病患者肠镜筛查,预防结直肠癌发生。结肠黑变病的病变程度、部位对结肠息肉的检出率、病理类型无影响。     

大肠黑变病3例报告

大肠黑变病是大肠粘膜一种非炎症性、良性、可逆性的色素沉着为特征的病变。是一种少见病,国内报道较少,但近年来发病率增高。我院今年1~11月行纤维结肠镜检查517例,现将结肠及病理检查证实大肠需变病3例报告如下。病例报告例1:男性,61岁。左下腹隐痛、腹胀、便秘、腹泻交替1年余。常服大黄、番泻叶等。结肠镜示:直肠至横结肠中段粘膜呈黑白相间虎皮样改变,血管     

大肠黑变病20例临床分析

大肠黑变病是大肠黏膜一种非炎症性、良性、可逆性的以色素沉着为特征的病变。近几年随着内镜检查的开展，大肠黑变病的诊断率逐步提高。现将我院2001-2005年内镜检查并经病理检查证实为大肠黑变病人20例，总结报告如下。     

结肠黑变病二例

结肠黑变病二例河南医科大学第二临床学院张亚琳，魏洪臣，赵治国结肠黑变病（Ｍｅｌａｎｏｓｉｓｃｏｅｉ）国内报道较少。我院１９９０年～１９９２年２４０１例纤维结肠镜检查中发现２例，均经病理证实，现报告如下。例１女性，８０岁，便秘、间断性左下腹隐痛３年余。...     

结肠黑变病伴结肠息肉的临床分析

目的 探讨结肠黑变病与结肠息肉甚至癌变的关系.方法 对经结肠镜检出的60例结肠黑便病患者的一般资料、镜下表现及病理进行回顾性分析.结果 结肠黑变病伴发结肠息肉较非结肠黑变病伴发结肠息肉的发生率明显增高,两组息肉大小无显著性差异,两组息肉病理分型无统计学意义.结论 及时进行结肠镜检查发现和切除息肉是防止结肠黑变病合并结肠息肉甚至癌变的重要手段.     

Melanosis of the ileum

Melanosis involving the small intestine is extremely rare though not uncommon in the colon and appendix. Light and electron microscopic studies of a rare case of melanosis of the ileum are described. Histochemical studies showed that the pigment in the ileum was similar to that reported in cases of melanosis coli and gave reactions for both melanin and lipofuscin. Electron microscopic study revealed this pigment to be in large mononuclear cells in the lamina propria. No pigment was found in epithelial or other cells. Despite the well-recognized ultrastructure and histochemical reactions of this pigment, its precise chemical structure and mode of formation need further elucidation. This study establishes the occurrence of pigmentation of the small bowel identical to that seen in the colon and designated melanosis coli.     

Melanosis coli

Summary The fine structure of the pigment of melanosis coli is described. This pigment differs from melanin and from the pigment of denervated muscle. It is suggested that the pigment granules are produced in the mononuclear cells of the tunica propria and have their origin in degenerating mitochondria. Supported by NIH Grant #CA 5676.     

78例结肠黑变病临床分析

目的 分析结肠黑变病(MC)的病因及与其结肠肿瘤的关系.方法 对78例结肠黑变病患者的临床资料进行回顾性分析.结果 便秘患者56例(23.1%),其中长期服用泻药患者38例(48.7%),无明确服泻药史患者18例(23.1%);合并有腺瘤样息肉16例;合并结肠癌1例.结论 便秘及服用泻药是导致MC发生的重要因素;泻剂中多为蒽醌类.结肠黑变病与结肠肿瘤的关系值得进一步研究.     

Overestimation of ulcerative colitis due to melanosis coli

Melanosis coli is a benign pigment deposition in the colonic mucosa that can be seen at the time of colonoscopy especially in patients with history of laxative use. In conditions in which the endoscopic findings influence therapeutic decisions, melanosis coli can lead to overestimation of disease aggressiveness and unnecessary therapy. We describe a case in which the finding of melanosis coli affected the treatment of a patient with mild ulcerative colitis exacerbation.     

Melanosis coli

The occurrence of large-bowel melanosis was evaluated by microscopy in 200 large bowels at autopsy. Melanin was seen as yellow-brown pigment in the macrophages of the lamina propria. The pigment stained with diastase-alcian blue PAS, Fontana, and iron stains. One hundred nineteen of 200 (59.5 percent) bowels showed melanosis, which was equally common in both sexes. Usually more than one segment was involved (most commonly, four segments). Melanosis was common in the proximal part of the colon, but much rarer in distal parts (sigmoid and rectum). Affected segments were successive; negative segments between positive ones were exceptional. If the rectum was affected, all five proximal segments were affected in 11 of 12 cases. The intensity of melanosis was directly related to the number of segments involved. In the oral part of the colon, affected males had a higher intensity of melanosis than affected women, but about the same intensity in the sigmoid and rectum. The fraction of patients with melanosis increased with age. Of men and women in the age group of 20 to 54 years, 32 and 44 percent were affected, and above the age of 75 years, 76 and 67 percent, respectively.     

Melanosis of the rectum in patients with chronic constipation

In patients with constipation the prevalence of melanosis in rectal biopsies was evaluated in an attempt to correlate its occurrence with laxative consumption and intestinal stasis. Melanosis was present in 58 percent of the patients and in none of a control group. Melanosis was present in 73.4 percent of patients consuming anthracene laxatives and in 26.6 percent of those not consuming anthracene laxatives (P<0.01). No correlation was found between the occurrence (and grading) of melanosis and pattern of transit through the large bowel, bowel movements, and duration of symptoms. Results of this study seem to indicate that intestinal stasis is not a cause of melanosis of the colon and rectum and confirm that melanosis may well be due only to the consumption of anthracene laxatives; melanosis coli does not appear to be a sensitive marker of impairment of motor function in the “cathartic colon.”     

Biopsies of the endoscopically normal rectum and colon: a necessity. Incidence of collagen colitis and microscopic colitis

Collagenous colitis and microscopic colitis are histologic entities which do not have corresponding endoscopic features. Their precise incidence and role in the development of intestinal symptoms are poorly known. The aim of this study was to determine the frequency of these histologic abnormalities in patients with endoscopically normal colon and to correlate these findings with abdominal symptoms. Total colonoscopy was performed in 132 consecutive patients, 81 females and 51 males, aged 19 to 83 years (mean: 47.8 years). Patients complained of abdominal pain and/or diarrhea (66 cases), normal bowel transit or constipation (66 cases). Subjects were prepared for colonoscopy with polyethylene glycol 4,000. Three to 8 biopsies were taken from the rectum and the different parts of the colon. Histologic abnormalities were found in 36 patients (27.2 p. 100): collagenous colitis (7 cases), microscopic colitis (21 cases), and melanosis coli (8 cases). The frequency of diarrhea was significantly higher in patients with collagenous colitis and microscopic colitis than in those with melanosis coli or normal colonic mucosa. These results clearly demonstrate that routine biopsies of the rectum and colon are useful in patients with abdominal symptoms, particularly diarrhea, and normal endoscopy.     

Melanosis of the esophagus. An endoscopic, histochemical, and ultrastructural study

Endoscopic, histological, and ultrastructural features of 21 cases of esophageal melanosis are described. These cases were detected during 1000 consecutive routine upper gastrointestinal endoscopies. Staining characteristics and ultrastructure of the pigment contained in the endoscopically visible lesions were found to be similar to those of true melanin.     

Laxative abuse

Two types of laxative abuse are described, namely habitual abuse and surreptitious abuse. Phenolphthalein and the anthraquinone derivatives have been most abused in this respect. Long-term anthraquinone use may lead to melanosis coli and cathartic colon, with typical histological and radiological features. Surreptitious abuse presents as a factitious illness with diarrhoea, hypokalaemia, abdominal pain and thirst, as well as melanosis coli. Over 90% of cases occur in women, many of whom work in a paramedical situation. Wider recognition of the range of normal bowel habit and a cultural change with rejection of Victorian mores and concepts of 'intestinal auto-intoxication' have led to a decrease in inappropriate laxative consumption. However, they are still widely prescribed and bought. Although it was as long ago as 1937 that Witts [108] drew attention to the dangers associated with the use of laxatives, his lesion still needs to be preached today.