结肠黑变病临床特点和内镜诊断分析(附145例报告)

[目的]探讨结肠黑变病(MC)的临床和内镜特点.[方法]对2004年1月～2009年12月经结肠镜检出的145例MC患者的临床资料、内镜下表现及并发息肉、肿瘤的检查结果进行回顾性分析.[结果]6 841例肠镜检查患者中检出MC145例,检出率2.11%;不同性别的检出率差异无统计学意义(P>0.05);>60岁的患者检出率明显高于<60岁患者(P<0.05);多数有便秘和(或)服用泻药病史;MC病变程度与服用泻药时间呈明显正相关(P<0.05).MC较易合并直径<0.5 cm的山田Ⅰ型结肠息肉.[结论]老年人易患MC;MC的发生与便秘和长期服用泻药有关;MC与结肠息肉、肿瘤发生有一定相关性,定期的肠镜随访是非常必要的.     

结肠黑变病临床特点和內镜诊断分析(附145例报告)

[目的]探讨结肠黑变病(MC)的临床和內镜特点。[方法]对2004年1月～2009年12月经结肠镜检出的145例MC患者的临床资料、内镜下表现及并发息肉、肿瘤的检查结果进行回顾性分析。[结果]6 841例肠镜检查患者中检出MC145例,检出率2.11%;不同性别的检出率差异无统计学意义(P0.05);60岁的患者检出率明显高于60岁患者(P0.05);多数有便秘和(或)服用泻药病史;MC病变程度与服用泻药时间呈明显正相关(P0.05)。MC较易合并直径0.5cm的山田Ⅰ型结肠息肉。[结论]老年人易患MC;MC的发生与便秘和长期服用泻药有关;MC与结肠息肉、肿瘤发生有一定相关性,定期的肠镜随访是非常必要的。     

全结肠黑变病的临床特征分析

[目的]探讨全结肠黑变病（MC）的临床特征。[方法]对近3年来诊断的90例全MC患者相关资料进行分析。[结果]90例中,便秘58例,45例长期或间断服用蒽醌类泻药,腹泻8例,并发结肠癌3例,结肠息肉28例,溃疡性结肠炎3例。[结论]全MC的发病与服用蒽醌类泻药及便秘有关,便秘及服泻药时间越长、服药量越大,其MC程度越重。全MC还可能与炎症性肠病及腹泻本身有关。该病是一种良性疾病,与结肠肿瘤的发生有一定关系,停用刺激性泻药,纠正习惯性便秘可以逆转病变。     

老年病科老年便秘331例服泻药与结肠黑变病关系的临床分析

目的探讨传统的中西药泻剂以及服药时间和方法与老年人结肠黑变病的关系. 方法总结了我科近7年住院老年便秘并服用泻剂331例患者结肠镜检查结果,根据便秘的病程及服用泻药的时间和方法分成4组,采用卡方检验分析了服药方式、时间与结肠黑变病的关系. 结果 331例患者中连续服药≥1年者,连续服药＜1年者,间断服药≥1年者和间断服药＜1年者结肠黑变病的发生率分别为81.06%,77.78%,11.25%和9.52%.显示连续服药者结肠黑变病发生率明显高于间断服药者(P＜0.01),而在连续服药者和间断服药者中,服药时间长短相差不显著(P＞0.05). 结论表明长期服用泻药与老年结肠黑变病的发生有相关性.但结肠黑变病确切的病理变化及临床意义有待进一步研究.     

结肠黑变病38例临床分析

目的探讨结肠黑变病的病因及其与结肠肿瘤的关系.方法对38例结肠黑变病患者的临床资料、镜下表现及病理进行回顾性分析.结果长期服泻药患者25例（65.8%）,未有明确服泻药史患者12例（31.6%）,不详1例;结肠癌患者0例,结肠息肉患者8例,病理示管状腺瘤患者6例,混合型患者2例.结论结肠黑变病病因可能与细胞凋亡有关;结肠黑变病与结肠肿瘤有密切关系.     

国人结肠黑变病与便秘和服用泻药关系不密切吗？

国人结肠黑变病与便秘和服用泻药关系不密切吗？中华消化杂志编辑部：贵刊１９９４；１４：３８文《结肠黑变病的病理探讨》提出国人结肠黑变病与国外患者的发病背景存在一定差别．其主要根据是国内患者发病与便秘和服用泻药关系不密切。但从文中提供的资料分析，似恰相关...     

结肠黑变病57例

目的:探讨结肠黑变病的病因、预后以及与肿瘤的关系.方法:回顾性2005-01/2008-12延边大学附属医院结肠镜检查发现的57例结肠黑变病患者临床特点.结果:2006-2008年结肠黑变病的发病率逐年增加(0.78%<0.92%<1.73%);57例患者中女性患者占52.6%, 但男性与女性无统计学差异,老年男性与中年女性发病率高(P <0.005);57例患者均有服用泻剂史,口服蒽醌类泻药(6年以上), 如潘泻叶、芦荟胶囊、麻仁润肠丸、排毒养颜胶囊43例, 果导片(6年以上)12例, 减肥茶(6-12 mo)2例;31例患者有便秘、每周<3次, 粪便干燥, 或呈块状;排便困难、排便不尽感21例;腹痛、腹胀2例;肛门坠胀不适者2例;腹泻、便血1例;有1例并发结肠癌;停用泻剂后随访3例6-12 mo, 2例黑变病减轻, 1例治愈, 预后良好.结论:结肠黑变病可能与便秘、长期服用泻药有关;好发于中年女性和老年男性;可能与结肠癌有关.     

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。     

86例结肠黑变病回顾分析

目的探讨结肠黑变病（MC）的发病特征、临床与内镜特点、发病原因及其与大肠腺瘤、大肠癌及溃疡性结肠炎的关系。方法选择2007年1月～2010年12月本院内镜室结肠镜检记录、相关病理记录及定期随访资料,进行数据分析。结果 2007年～2010年MC检出率呈逐年上升趋势;老年患者检出率高于中青年（P〈0.01）,男性患者多集中在老年（P〈0.01）,女性患者检出率无年龄差异,老年患者检出率无性别差异,中青年患者女性检出率高于男性（P〈0.01）;便秘为MC最常见症状,其次是腹痛;病变可累及各肠段;长期便秘及服用蒽醌类泻剂易患MC;MC与结肠腺瘤病发病密切相关（P=0.012）,与结肠癌和溃疡性结肠炎无明显相关性。停用蒽醌类泻药结肠黑变能治愈或明显减轻。结论 MC的检出率呈逐年增加的趋势;老年人及中青年女性易患本病;临床表现缺乏特异性;容易合并结肠腺瘤;便秘及服用蒽醌类泻剂与MC密切相关;MC预后良好。     

老年便秘331例服泻药与结肠黑变病关系的临床分析

目的：探讨传统的中西药泻剂以及服药时间和方法和老年人结肠黑变病的关系。方法：总结了我科近7年住院老年便秘并服用泻剂331例患者结肠镜检查结果，根据便秘的病程及服用泻药的时间和方法分成4组，采用卡方检验分析了服药方式，时间与结肠黑变病的关系。结果：331例患者中连续服药≥1年者，连续服药＜1年，年者，间断服药≥1年者和间断服药＜1年者结肠黑变病的发生率分别为81．06％，77．78％，11．25％和9．52％，显示连续服药者结肠黑变病发生率明显高于间断服药者（P＜0．01），而在连续服药者和间断服药者中，服药时间长短相差不显著（P＞0．05）。结论：表明长期服用泻药与老年结肠黑变病的发生有相关性，但结肠黑变病确切的病理变化及临床意义有待进一步研究。     

结肠黑变病的病理探讨

结肠黑变病国外文献报道较多，国内文献很少。我们收集解放军总医院１９８５～１９９０年２２８３例纤维结肠镜检查中发现的黑色病变并取活检经病理证实的１３４例进行临床病理分析，主要对其中２２例进行超微结构观察。结果发现结肠黑变病是一种较常见的大肠病变，与便秘和服用泻药关系不密切。电镜观察见纤维母细胞亦有吞噬色素的现象等。说明对中国人的大肠黑变病有必要进行深入的研究。     

Anthranoid laxative use is not a risk factor for colorectal neoplasia: results of a prospective case control study

BACKGROUND: Anthranoid laxatives are the most commonly used purgatives in the therapy of acute and chronic constipation. Recent experimental data and a prospective cohort study provide evidence of a possible risk of anthranoid use for the development of colorectal neoplasms. MATERIALS AND METHODS: We performed a prospective case control study at the University of Erlangen to investigate the risk of anthranoid laxative use for the development of colorectal adenomas or carcinomas. A total of 202 patients with newly diagnosed colorectal carcinomas, 114 patients with adenomatous polyps, and 238 patients (controls) with no colorectal neoplasms who had been referred for total colonoscopy were studied. The use of anthranoid preparations was assessed by standardised interview, and endoscopically visible or microscopic melanosis coli was studied by histopathological examination. RESULTS: There was no statistically significant risk of anthranoid use for the development of colorectal adenomas (unadjusted odds ratio 1.0; 95% CI 0.5-1.9) or carcinomas (unadjusted odds ratio 1.0; 95% CI 0.6-1.8). Even after adjustment for the risk factors age, sex, and blood in the stools by logistic regression analysis the odds ratio for adenomas was 0.84 (95% CI 0. 4-1.7) and for carcinomas 0.93 (95% CI 0.5-1.7). Also, there were no differences between the patient and control groups for duration of intake. Macroscopic and high grade microscopic melanosis coli were not significant risk factors for the development of adenomas or carcinomas. CONCLUSION: Neither anthranoid laxative use, even in the long term, nor macroscopic or marked microscopic melanosis coli were associated with any significant risk for the development of colorectal adenoma or carcinoma.     

老年人大肠黑变病的临床和内镜特点分析

目的探讨老年人大肠黑变病(Melanosis coli,MC)的病因及其临床和内镜特点。方法总结我院自2000年-2010年间电子结肠镜检查4 821例中发现60岁以上58例老年MC的临床资料,并进行回顾性分析。结果老年MC病变多累及1个或多个肠段,全结肠发病率较高,58例中25例伴有大肠息肉,其中大肠腺瘤23例,5例伴有结肠癌,便秘49例,服用泻药53例。结论老年MC的病因主要与便秘和长期服用蒽醌类泻药有关,其伴发大肠息肉和结肠癌几率增加。     

大肠黑变病35例临床分析

目的探讨大肠黑变病的致病因素和临床特点。方法回顾性分析我院2007年1月～2011年6月经结肠镜和病理检查确诊的35例大肠黑变病患者的临床资料、内镜及病理特点。结果 35例患者中,有慢性便秘症状者28例,服用泻药者32例,合并增生性息肉3例,合并管状腺瘤1例,合并直肠腺癌1例。结论大肠黑变病病因与长期服用泻药及慢性便秘有关,并与大肠腺瘤和大肠癌相关。     

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.”     

Anthranoid self-medication causing rapid development of melanosis coli

It is widely known that long-term use of anthranoid-containing laxatives is the cause of melanosis coli. We describe a case of melanosis coli, which occurred in a 39-year-old liver transplant patient who took an over-the-counter product containing aloe, rheum and frangula. The typical brownish pigmentation of the colonic mucosa developed in a period of ten months. The anthranoid medication was stopped and follow-up colonoscopy one year later showed normal looking mucosa once more. However, in contrast to previous examinations, a sessile polypoid lesion was found in the transverse colon. Histology showed tubulovillous adenoma with extensive low-grade dysplasia. Since there have been preliminary reports suggesting a possible role of anthranoid-containing laxatives in the development of colorectal adenomas and cancer, their use should be discouraged.     

老年便秘患者350例肠镜结果分析

目的探讨老年便秘患者和内镜下发现的肠道疾病之间的关系。方法归纳上海中医药大学附属曙光医院2009年7月至2013年7月350例老年便秘病例的结肠镜结果,结合老年便秘患者病程、性别并归纳分析镜下肠道疾病的分布特点。结果350例老年便秘病例肠道疾病发现率高达60．86％,相关大肠疾病发病率依次为结直肠炎（26．86％）、结肠黑变病（13．14％）、肠息肉（12．00％）、结直肠癌（6．57％）、炎症性肠病（1．14％）、结肠憩室（0．57％）、肠结核（0．29％）、毛细血管扩张症（0．29％）。男性便秘病例肠息肉、结直肠癌检出率高于女性（P〈0．05）。便秘病程〉5年组结肠黑变病发生率较高（P〈0．05）。结论老年人便秘的最主要病因是结直肠疾病,尽早行结肠镜检查,明确病因,对症治疗,是提高老年人生活质量的关键。     

蒽醌类中药致结肠黑变病发病机制探讨

[目的]探讨蒽醌类中药致结肠黑变病（MC）发病机制.[方法]复习22例MC的临床病理资料,并对其组织病理学进行观察分析.[结果]22例均有便秘及服用含蒽醌苷类中药泻剂经历,结肠镜及病理检查都显示不同程度的MC的表现.[结论]西医认为MC发生于结肠上皮细胞凋亡及慢性结肠梗阻有关;中医认为MC由肝肾阴虚,气郁血虚,肠壁失养所致.     

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。     

Anthranoid laxative abuse--a risk for colorectal cancer?

Anthranoid-containing laxatives--aloe, cascara, frangula, and rheum--may play a role in colorectal cancer. This risk is particularly important in view of the wide abuse of self administered laxatives for chronic constipation. There are data on the genotoxic potential of anthranoids and there is evidence of a tumourigenic potential in rodents. A case report and clinical-epidemiological studies have evaluated the cancer risk in patients who have abused anthranoid laxatives over a long period. Pseudomelanosis coli is a reliable parameter of chronic laxative abuse (> 9-12 months) and is specific for anthranoid drugs. In a retrospective study of 3049 patients who underwent diagnostic colorectal endoscopy the incidence of pseudomelanosis coli was 3.13% in patients without pathological changes. In those with colorectal adenomas, the incidence increased to 8.64% (p < 0.01), and in those with colorectal carcinomas it was 3.29%. This lower rate was probably caused by incomplete documentation of pseudomelanosis coli in those with carcinoma. In a prospective study of 1095 patients, the incidence of pseudomelanosis coli was 6.9% for patients with no abnormality seen on endoscopy, 9.8% (p = 0.068) for patients with adenomas, and 18.6% for patients with colorectal carcinomas. From these data a relative risk of 3.04 (1.18, 4.90; 95% confidence interval) can be calculated for colorectal cancer as a result of anthranoid laxative abuse.