52例缺血性结肠炎临床诊治分析

目的 探讨缺血性结肠炎(IC)的临床表现及内镜特点,进一步提高对该病的认识.方法 回顾性分析1999年6月至2009年8月52例IC患者的临床表现及内镜所见的相关资料.结果 本组病例中,38例(73.08%)患有血管相关性疾病,临床表现主要为急性腹痛、腹泻、便血三联征.内镜所见:病变部位主要发生在乙状结肠35例(67.31%),病变范围4～35 cm.结论 缺血性结肠炎急性发作时腹痛是其共同临床特点,内镜检查是诊断本病的有效方法.提高对该病的认识,特别是对伴有基础疾病者,应早期进行结肠镜检查,对尽快明确诊断有重要意义.     

钾离子敏感试验与间质性膀胱炎PUF评分的相关性研究

目的 探讨钾离子敏感试验(PST)与间质性膀胱炎(IC)盆腔疼痛和尿频、尿急症状(PUF)评分的相关性及意义.方法 IC患者14例.女13例,男1例.平均年龄48岁.临床表现主要为尿频、尿急、膀胱克盈后耻骨上及会阴区疼痛.14例均依据美国糖尿病、消化及肾病协会(NIDDK)IC诊断标准确诊.采用膀胱水囊扩张后碳酸氢钠、利多卡因及肝素钠灌注治疗.治疗前后均行PST评分和PUF评分,并分析二者之间的关系.结果 14例患者治疗前后PST评分中位数分别为4.0、1.0,PUF评分中位数分别为27.5、13.5,治疗前后差异均有统计学意义(P<0.01).PST评分与PUF评分呈正相关(治疗前rs=0.868,t=4.418,P=0.001;治疗后rs=0.779,t=4.300,P=0.001).结论 PST和PUF评分在IC中表现出一致性,可单独作为IC诊断、鉴别诊断、病情严重程度及治疗效果判定的重要指标.     

缺血性结肠炎重症误诊分析

目的 对缺血性结肠炎(IC)的临床表现及诊治过程进行探讨,分析误诊因素.方法 对2017年1月至2019年9月间17例IC病人临床表现特点,诊疗过程进行分析.除2例腹膜炎病人未行肠镜检查,行外科手术治疗外,其余病情较平稳者均早期肠镜检查明确诊断.15例行抗炎、控制饮食、改善循环、抗凝、补液等治疗后康复;另2例出现腹膜炎...     

溃疡性结肠炎的诊治现状与进展

溃疡性结肠炎 (ｕｌｃｅｒａｔｉｖｅｃｏｌｉｔｉｓ ,ＵＣ)是消化病学研究的一个热点。一、诊断ＵＣ的诊断并不困难 ,主要依靠临床表现和辅助检查 ,其中内镜检查是目前最有助于确诊的手段。诊断中注意如下几点 :1.多见于青少年 ,病变主要局限于大肠 ,特别多见于直肠及乙状结肠。2 .主要临床表现是腹痛、便血、腹泻和发热 ,也可能有贫血、疲倦、食欲不振及体重下降。如累及直肠者常伴有里急后重 ,很快出现血便。3.影像学检查 :(1)钡剂灌肠Ｘ线所见 :ＵＣ早期粘膜皱襞紊乱 ,肠壁呈锯齿状 ,肠腔有一小龛影 ,典型表现为肠管管壁缩窄、变短、呈…     

尿液分子标记物在间质性膀胱炎诊断中的应用

间质性膀胱炎(Interstitial cystitis, IC)是一种主要发生在女性,以尿频、尿急,膀胱充盈性疼痛为临床特征的器质性病变.IC临床表现与慢性骨盆痛综合征、膀胱炎、前列腺炎和膀胱过度活动综合征相似,缺乏有效的鉴别诊断手段,影响了IC的诊疗效果.近年来,在IC患者的尿液中发现一些与IC相关的特异性和敏感性标记物,可能为IC的诊断与鉴别诊断提供一种有效、无创的判定方法 .本文就IC患者尿液中的分子标记物的研究进展作一.     

缺血性结肠炎临床特征分析：附101报告

背景与目的:缺血性结肠炎(IC)是缺血性肠病中常见的一种类型,也是临床诊断较为困难的一种疾病,早期误诊率高,部分患者发病后病情急剧恶化,病死率较高。本文总结分析IC的临床特点,以期为该病的临床诊治提供参考。方法:回顾2010年1月—2019年9月中南大学附属湘雅医院收治的101例IC患者的临床资料。分析患者的一般资料、临床表现、内镜下特点和疾病转归情况,并比较不同年龄组患者临床特征的差异。结果:101例均为初发IC患者,其中女性62例(61.4%);年龄为45～93岁,平均年龄为(63±8.8)岁。包括45～60岁39例(中年组),≥60岁62例(老年组)。患者主要症状为便血、下腹痛、恶心、腹胀;结肠镜下主要表现为黏膜充血、水肿、血管纹理紊乱、糜烂和溃疡;左半结肠受累69例(68.3%)、右半结肠受累7例(6.9%)、广泛结肠受累25例(24.8%)。81例(80.2%)行腹腔血管检查,其中提示不同程度的血管狭窄者或血栓形成25例(30.9%),仅动脉硬化者14例(17.3%),无明显异常者42例(51.8%)。大多数行内科保守治疗,症状缓解时间为1～35 d,平均(9.5±4.3)d。老年组与中年组患者性别构成比、结肠受累部位、主要症状缓解时间、总治愈率差异无统计学意义(均P0.05);老年组患有高血压、冠心病及脑部血管疾病史比例明显多于中年组,腹腔动脉狭窄、腹腔动脉硬化比例高于中年组(均P0.05)。结论:IC好发于老年人,且女性易发病,主要症状为下腹痛及血便,好发于左半结肠。及时进行结肠镜检查有利于IC的确诊。目前IC的主要治疗手段以内科保守治疗为主,老年IC患者合并基础疾病多,腹腔血管条件差,临床工作中应注意正确诊断、早诊早治,改善预后。     

十二指肠憩室的诊断与治疗

目的 探讨十二指肠憩室的临床表现,诊断和治疗.方法 回顾性分析2年7个月期间收治的105例患者的临床资料.结果 全组患者症状以腹痛多见(54例),其次是以返酸、恶心、呕吐等症状(21例),主要经消化道造影检查和内镜检查诊断.68例行保守治疗,其中1例出现病情反复,行憩室旷置术(胃大部切除、胃肠吻合术,Billroth Ⅱ).37例经外科治疗,其中22例因合并胆道系统疾病行相关手术；11例反复发作憩室炎行憩室旷置手术(5例)或切除手术(6例)；4例行其他手术.105例均随访1年,未见明显不适.结论 十二指肠憩室的症状以腹痛为主,多经消化内镜和消化道造影诊断,多数可以保守治疗,外科治疗需严格掌握手术适应证.     

原发性胃肠道恶性淋巴瘤64例临床分析

目的探讨原发性胃肠道恶性淋巴瘤的发病、诊断、治疗.方法对64例经病理证实的原发性胃肠道恶性淋巴瘤的临床资料并结合相关文献进行回顾性分析.结果本病占同期胃肠恶性肿瘤的2.7%,64例患者平均年龄39.5岁.好发部位顺序为回盲部及回肠(54.69%)、胃(21.875%)、结肠(14.06%)、直肠(9.375%).主要临床表现是腹胀、腹痛、腹部包块、腹泻、血便.病理类型本组64例中,非何杰金氏淋巴瘤58例,其中B细胞型52例,T细胞型6例;何杰金氏淋巴瘤6例.本病早期极易误诊为其它消化道疾病,误诊率为67%.结论原发性胃肠道恶性淋巴瘤的诊断应综合临床表现、影像学及内镜检查结果,以提高诊断符合率.治疗以手术加化疗、放疗疗效最佳.     

中国江苏地区间质性膀胱炎/膀胱疼痛综合征患者现状调查

目的 了解江苏地区泌尿外科间质性膀胱炎/膀胱疼痛综合征(IC/BPS)患者的诊断及治疗现状,提高临床医师对于这一疾病的认知度.方法 2014年10月至2015年9月在江苏省13个城市28个泌尿外科进行横断面调查研究,对在调查时间内前来泌尿外科就诊的患者进行IC/BPS诊断的询问筛查,选择部分患者进行详细的问卷调查及IC/BPS相关检查.结果 参与调查共184例IC/BPS患者.53例(28.8％)为初诊,其余131例(71.2％)为复诊.主要描述症状:尿急43例(23.4％),尿频76例(41.3％),夜尿18例(9.8％),疼痛47例(25.5％).治疗方案中单一用药22例(12.0％),联合用药162例(88.0％).女性患者平均ICSI、ICPI、OABSS、VAS、QOL评分均高于男性,最大排尿量较少(P＜0.05).男性α受体阻滞剂及植物药应用较多,女性M受体阻滞剂及膀胱内治疗应用较多(P＜0.05).结论 IC/BPS严重影响生活质量,目前临床应用的检查及治疗方案与国际上有一定差异,需要提高医师对疾病的认识.     

内镜下电灼术治疗溃疡型膀胱疼痛综合征/间质性膀胱炎患者临床研究

目的:探讨内镜下电灼术治疗溃疡型膀胱疼痛综合征/间质性膀胱炎患者(bladder pain syndrome/interstitial cystitis;BPS/IC)的临床有效性和安全性。方法:所有患者在膀胱镜检+水扩张后,病理回报明确为非特异性炎症者,排除恶性肿瘤疾病,明确为BPS/IC诊断后,分为溃疡型和非溃疡型。随机选取32例溃疡型BPS/IC患者行膀胱溃疡内镜下电灼术治疗。观察手术治疗前后(术后随访1、3、6个月)病情变化如:临床症状情况(每日排尿次数、最大排尿容量、膀胱区疼痛程度评分)和O’Leary-Sant间质性膀胱炎问卷表评分及生活质量评分(QOL)情况。结果:32例溃疡型BPS/IC患者,男5例,女27例,年龄36～60岁,平均(47.0±6.2)岁;病程1～5年,平均(3.5±1.2)年。本组患者症状改善总有效率78.1%(25/32),其中完全缓解率为53.1%(17/32),部分缓解率为25%(8/32),治疗无效率为21.9%(7/32)。手术治疗后患者平均每日排尿次数、每次排尿量、疼痛程度、O’Leary-Sant评分、生活质量评分与治疗前相比均存在显著改善(P<0.01)。结论:内镜下电灼术治疗溃疡型BPS/IC患者能够有效缓解临床症状和改善生活质量。     

缺血性结肠炎26例临床分析

为探讨缺血性结肠炎的临床表现及分型治疗．对26例缺血性结肠炎患者的临床表现、内镜检查、病理结果及治疗进行回顾性分析。结果显示,缺血性结肠炎好发于老年人,主要临床表现为突发性左侧腹痛、便血及腹泻。内镜检查可见病变部位多位于左半结肠,表现为结肠黏膜充血、坏死、糜烂及黏膜下出血,溃疡形成。采用扩张血管治疗效果良好。结果表明,老年人突发性左侧腹痛及便血时应警惕缺血性结肠炎的可能,及早进行结肠镜检查,早期治疗,对该病预后具有重要意义。     

Endoscopic ablation of Hunner’s lesions in interstitial cystitis patients

Introduction:

We report our experience with endoscopic ablation of Hunner’s lesions in women with interstitial cystitis (IC).

Methods:

A chart review was performed on 14 patients with IC symptoms who were identified to have bladder lesions and underwent endoscopic ablation. A Hunner’s lesion was identified as an area of erythema that reproduced the patients’ pain when touched by the cystoscope. Pathology reports were reviewed and improvement in pain was used as the main outcome measure.

Results:

Of the 14 patients, 12 had more than 50% symptomatic improvement and 8 patients reported 100% improvement. Mean improvement was 76%. In all patients who improved, the biopsy specimen showed inflammatory cystitis, often with epithelial denudation. Four patients had symptomatic recurrence, but all had improvement after repeat ablation.

Conclusion:

Endoscopic ablation of Hunner’s lesions improves symptoms in IC patients. Recurrence of symptoms should prompt repeat cystoscopy to identify recurrent lesions, as repeat ablation offers symptomatic improvement.     

Interstitial cystitis/painful bladder syndrome: diagnostic evaluation and therapeutic response in a private urogynecology unit

Background

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a spectrum of pelvic, bladder or urethral pain, as well as irritative voiding symptoms. The term interstitial cystitis (IC) is reserved for patients with typical cystoscopic features. Diagnosis and management of this syndrome may be difficult. The aim of this study was to describe endoscopic features and our experience on the treatment of this syndrome in Urodifem de Occidente S.C., a private urogynecology unit.

Methods

Observational, retrospective analytic study of 25 treated patients from 33 with diagnosis of IC/PBS between January 2001 and March 2015. The diagnosis was done by clinical, cystoscopic and urodynamic approach. Treatment was based on bladder instillation of dymetilsulfoxido (DMSO), dexamethasone and heparin. Oral pentosan polysulphate was prescribed for at least 1 year.

Results

Cystoscopic findings showed petechial hemorrhages in 32%, Hunner’s lesions in 28%, glomerulations in 28% and bladder pain in absence of lesions in 12%. The basic treatment included one instillation once a week for 6 weeks, twice a month for 2 months and four monthly instillations. Three cases had complete remission of their symptoms, 21 had significant improvement and we have only one failure.

Conclusions

We recommend the combined use of DMSO instillation and pentosan polysulphate (PPS) in cases of IC/PBS.     

The value of laparoscopy in acute pelvic pain.

Laparoscopy was performed in 223 patients with acute pelvic pain but without a definite diagnosis. The clinically suspected diagnosis was confirmed by laparoscopy in only 57 patients (25%). Laparotomy was thus avoided in 145 patients (65%). The endoscopic findings in the three clinical entities included here are presented: tubal pregnancy, acute appendicitis or torsion of adnexal mass. This study emphasizes the poor correlation between the clinical diagnosis based on history, pelvic examination and physical signs, and the final laparoscopic findings. The value of laparoscopy in evaluation of acute pelvic disease is stressed.     

Clinical characteristics differ considerably between phenotypes of bladder pain syndrome/interstitial cystitis

Abstract Objective. Bladder pain syndrome/interstitial cystitis (BPS/IC) is one of the most bothersome conditions in urological practice. This syndrome includes a heterogeneous collection of underlying pathological conditions. Compared to the classic IC with a Hunner lesion, now denominated European Society for the Study of Interstitial Cystitis (ESSIC) type 3C, the non-Hunner type of BPS/IC appears different concerning demographic, endoscopic and histological findings, as well as the response to all forms of treatment. The objective of this study was to determine whether there are additional dissimilarities in clinical presentation between the main phenotypes of BPS/IC. Material and methods. In total, 393 BPS/IC patients (210 type 3C and 183 non-Hunner), diagnosed according to National Institute of Diabetes and Digestive and Kidney Diseases and ESSIC criteria, were studied by surveying the clinical records including micturition diaries. Results. In this clinical material, BPS/IC ESSIC type 3C accounted for 55% of cases. Patients with non-Hunner disease were on average 20 years younger at the time of diagnosis. Furthermore, there was a marked and significant difference in bladder capacity under general anaesthesia (p < 0.0001). Conclusions. The findings in the present series, together with previously published reports by this group and by others, confirm the striking differences between the main forms of BPS/IC and underline the indispensability of adequate subtyping in clinical studies.     

内镜早期治疗急性胆源性胰腺炎60例临床研究

目的：探讨内镜早期治疗急性胆源性胰腺炎（ABP）的临床疗效。方法：ABP患者120例,根据治疗方法的不同随机分为早期内镜治疗重症ABP组（Ⅰ组）、早期内镜治疗轻症ABP组（Ⅱ组）、保守治疗重症ABP组（Ⅲ组）以及保守治疗轻症ABP组（Ⅳ组）,每组30例,评价各组的临床疗效。结果：Ⅰ组及Ⅱ组恶心、呕吐、发热、腹痛等症状和体征以及TNF-α、C反应蛋白（CRP）、IL-6、IL-8、血淀粉酶、尿淀粉酶、直接胆红素、谷氨酰转肽酶、碱性磷酸酶等实验室检查指标,在治疗前后的改善情况显著优于其他2组,病程缓解时间也短（P〈0.05）;Ⅰ组和Ⅱ组的治疗总有效率为93.3%和90.0%,明显优于Ⅲ组的70.0%和Ⅳ组的76.7%（P〈0.05）。结论：对ABP患者采用内镜早期治疗,相比保守治疗更能有效改善患者的临床症状和体征,值得临床推广。     

Clinical evaluation of 30 patients with interstitial cystitis complicated by fibromyalgia

PURPOSE: Although interstitial cystitis (IC) complicated by fibromyalgia (FM) is yet unreported in Japan, we encountered patients with the complications almost as frequently as in the USA. We report the present status of such patients and the significance of this complication. PATIENTS AND METHODS: We evaluated the clinical findings of 30 patients with IC complicated by FM in the last four years. RESULTS: Average IC symptom index and problem index was 14.9 and 14.6, respectively. Average numbers of tender points for the criteria for FM was 16 locations. Both diseases have some similarities in the decrease in pain threshold, extensive pain, factors exacerbating symptoms and treatment methods. CONCLUSION: Approximately 11% of patients with IC have a complication of FM. They feel isolated due to the lack of understanding of the disease and endure generalized intolerable pain.     

中老年缺血性结肠炎16例临床分析

为总结中老年缺血性结肠炎的临床特点及内镜特征,回顾分析16例中老年缺血性结肠炎患者的临床诊治资料及内镜特征。结果显示,女性多见（男：女为1：2．2）,且多数患者伴有心脑血管疾病、糖尿病、便秘等基础疾病及腹部手术史或诱因。临床主要表现为突发性左下腹疼痛、便血、腹泻三联征。病变部位主要发生在左半结肠．内镜下表现为与正常黏膜界限分明的结肠黏膜水肿、充血、糜烂、溃疡及增生性改变,病变多为一过型,如能早期诊断与治疗,多数预后良好。结果表明。中老年人出现急性腹痛及便血时应警惕缺皿性结肠炎的可能,早期诊断和治疗是预后良好的关键。     

Evaluation of upper gastrointestinal endoscopy as a primary investigation in patients with acute upper abdominal pain

Fifty-six consecutive patients presenting to one general surgical unit with acute upper abdominal pain were submitted to early diagnostic endoscopy after exclusion of perforation, pancreatitis and gallstone disease. Endoscopy was performed within 48 h of admission in 84% of patients and 68% of the study group were discharged within 48 h of the procedure. In 26 patients a definite causative pathology was identified. In 13 patients there were mucosal changes of doubtful significance, while in 17 patients the examination was normal. Endoscopy in patients admitting to excess alcohol intake was generally unrewarding and there was poor correlation between the clinical diagnosis of peptic ulcer and endoscopic findings. The clinical diagnosis was revised in 64% of patients following endoscopy. The data from this study suggest that early endoscopy in acute upper abdominal pain results in a high yield of positive findings, permits rapid correction of diagnostic errors and facilitates early institution of management and discharge.