结肠镜检查对缺血性结肠炎的诊断价值

目的探讨缺血性结肠炎的临床、内镜特点及早期诊断方法。方法35例缺血性结肠炎患者在腹痛症状出现后72h内行全结肠内镜及病理检查,并于首次检查后2周～2个月内复查结肠镜,部分病例取病变黏膜活检,观察其内镜下表现及临床病理特点。结果35例患者临床主要表现为腹痛、血便及腹泻等,病变全部位于左半结肠。一过性炎症型33例,狭窄型2例;病理学表现无特异性。结论早期行结肠镜检是诊断缺血性结肠炎的主要方法。     

溃疡性结肠炎患者直肠肛门动力和感觉功能变化

溃疡性结肠炎常见,主要表现为腹痛、腹泻、脓血便、纤维结肠镜检为结肠粘膜弥漫性充血、水肿、糜烂和溃疡;大多数患者以左半结肠病变为主。Reddy et al报道,溃疡性结肠炎患者不仅存在粘膜病变,也存在结肠动力异常,表现为推进性小振幅收缩增多,但直肠肛门动力和感觉功能有何改变尚不清楚,现研究如下。 1 材料和方法 1.1 材料溃疡性结肠炎活动期患者12例,男9例,女3例,年龄23岁～45岁,平均30.2岁,均经纤维结肠镜检查并符合溃疡性结肠炎诊断标准。用SASP及灌肠等治疗2wk～4wk,临床症状基本消失,肠镜检查示结肠粘膜糜烂和溃疡愈合。健康人10例,男8例,女2例,年龄22岁～40岁,平均28.6岁。无胃肠道症状和手术史,无肛周疾病和痔疮。所有病例近1wk均未服用影响胃肠道动力的药物。     

老年缺血性结肠炎的内镜及临床特点

目的总结老年缺血性结肠炎患者的内镜及临床特点,探讨其早期诊断方法。方法收集分析2000年1月～2007年12月,经临床、结肠镜确诊的老年缺血性结肠炎患者的相关资料,89例患者均在腹痛等症状出现后10天内行全结肠镜检查,部分病例取病变黏膜活检,观察其内镜下表现及病理组织学特点。结果经临床、结肠镜确诊为老年缺血性结肠炎者90例,其中男25例、女65例,男女之比为1：2．6,年龄为60～90岁,平均年龄（73．31±6．63）岁,多伴有相关基础疾病。临床主要表现为腹痛和血便,病变多数位于左半结肠。一过型者86例,狭窄型4例,无坏疽型。病理学表现无特异性。结论老年病人出现急性腹痛、便血时,及时结肠镜检查对明确缺血性结肠炎诊断,了解病变范围和分犁具有重要意义。     

缺血性结肠炎34例内镜表现及临床分析

目的总结缺血性结肠炎的临床、内镜表现特点及诊治要点。方法回顾性分析我院34例缺血性结肠炎患者的临床资料。结果缺血性结肠炎好发于中老年人,常合并高血压等基础疾病,以腹痛、腹泻、便血为主要临床表现,内镜检查病变主要位于左半结肠。呈节段性分布,多为一过型,及早诊治后恢复良好。结论具有相关基础疾病的中老年人发生腹痛、便血者,应尽早行结肠镜等检查明确诊断,确诊后及时治疗．提高临床治愈率。     

缺血性结肠炎的内镜及临床特点

目的 总结缺血性结肠炎的内镜及临床特点。探讨其早期诊断方法。方法 收集分析1975年6月至2000年12月经结肠镜发现，病理确诊的36例缺血性结肠炎的相关资料。所有病例均在腹痛等症状出现后5d内行全结肠内镜及病理检查，并于首次检测后2周至2个月内复查大肠镜，部分病例取病变黏膜活检，观察其内镜下表现及临床病理特点。结果 经结肠镜检查确诊的36例缺血性结肠炎患者，男12例，女24例，年龄为35-84岁，平均年龄为60.5岁，其中50岁以上31例，临床主要表现为腹痛，血便及腹泻等，病变多数位于左半结肠。一过性炎症型者30例，狭窄型5例，仅有1例坏疽型，病理学表现无特异性，结论 早期行结肠镜检查是诊断缺血性结肠炎的主要方法。     

缺血性结肠炎44例临床分析

目的探讨缺血性结肠炎的临床特点、内镜特征和诊治要点。方法回顾性分析2003年1月～2007年6月44例缺血性结肠炎的临床资料．结果缺血性结肠炎好发于老年人，多伴有相关基础疾病，主要临床表现是急性下腹痛和便血。内镜检查提示病变主要发生在左半结肠，呈节段性分布，结肠黏膜高度水肿、充血、糜烂、坏死及溃疡。大多数病例呈一过性表现，如能早期诊断与治疗，预后良好。结论急性腹痛和便血且伴有心、脑血管疾病及糖尿病的老年患者应考虑有缺血性结肠炎可能，病变转归与发病年龄、病变程度及病程长短、伴随的基础疾病及有无并发症可能相关。内镜检查在明确诊断、早期治疗和判断预后上具有重要意义。     

缺血性结肠炎的临床特点及诊断方法

本文对２５例缺血性结肠炎进行回顾性分析，探讨其临床特点及诊断方法，突出症状为突发下腹痛和血性腹泻（９２％）２０例（８０％）伴有高血压，冠心病，便秘，糖尿病及既往下腹部手术史等基础疾病呀诱因。Ｘ线造影和内镜检查为主要诊断依据，尤基是急性期的大肠镜检查最有意义，可见病变肠管呈节段性分布，与正常肠管界限清晰，表现为粘膜充血，水肿麻醉烂和溃疡形成。本组病变位于左半结肠者２４例，升结肠１例，属一过型２０例，     

缺血性结肠炎37例

目的:探讨缺血性结肠炎的临床特点、内镜特征及诊断和治疗方法.方法:对37例缺血性结肠炎患者的临床表现、易患因素、结肠镜检查、患者的转归等资料进行回顾性分析.结果:缺血性结肠炎多发于老年患者,其中＞60岁者占70.3%(26/37).多伴有高血压、冠心病、糖尿病以及脑血管病等基础疾病.腹痛、腹泻以及便血为主要临床表现.结肠镜下以黏膜充血、水肿、糜烂、溃疡等为主要表现,为非特异性表现,病变主要见于左半结肠,呈节段性分布.多数患者预后良好,27例(72.9%,27/37)患者基本愈合.结论:老年患者出现急性腹痛,腹泻以及便血应注意缺血性结肠炎可能,早期结肠镜检查,综合临床分析可及时明确诊断指导治疗.结肠镜检查时应该小心操作因为肠镜检查本身可以诱发缺血性结肠炎.     

65例缺血性结肠炎临床特点及内镜表现分析

目的探讨缺血性结肠炎的临床特点、内镜表现及诊治要点。方法回顾性分析65例缺血性结肠炎的临床资料及内镜特征。结果缺血性结肠炎好发于老年人,多有相关的基础疾病,以腹痛、腹泻、便血为主要表现,内镜检查病变主要发生在左半结肠,呈节段性分布,大多数病例呈一过性改变,预后良好。结论具有相关基础疾病的老年人发生腹痛、便血者,应考虑到缺血性结肠炎的可能,早期诊断和治疗是预后良好的关键。     

缺血性结肠炎43例临床分析

目的 探讨缺血性结肠炎的临床表现、内镜特征及诊治方法.方法 回顾性分析43例缺血性结肠炎患者的临床资料.结果 缺血性结肠炎多发于60岁以上中老年女性患者,尤其伴有糖尿病以及心、脑血管等基础疾病者.腹痛、腹泻及便血为主要临床表现.结肠镜下以黏膜充血、水肿、糜烂、溃疡等为主要表现,病变主要见于左半结肠,呈节段性分布,病变与正常黏膜分界清楚,多数患者预后良好.结论 中老年人(尤其合并有心脑血管及糖尿病等疾病者)出现不明原因的腹痛、腹泻、便血者应考虑缺血性结肠炎可能,应尽早行结肠镜检查,必要时行血管造影或其他影像学检查.此外,结肠镜检查过程中有诱发缺血性结肠炎的可能.     

Endoscopic Findings and Clinicopathologic Characteristics of Ischemic Colitis: A Report of 85 Cases

Ischemic colitis is the most common type of intestinal ischemia and has a clinical spectrum of injury that ranges from mild and transient ischemia to acute fulminant colitis. The aim of this study was to explore endoscopic findings and clinicopathologic characteristics of ischemic colitis and be accurate enough to avoid missed diagnosis or misdiagnosis. A retrospective analysis was undertaken of endoscopy findings and clinicopathologic characteristics of 85 cases of ischemic colitis from March 2005 to April 2008 in the endoscopy center of our hospital. All cases underwent colonoscopy with biopsy within 2 weeks of the onset of symptoms, and all specimens with forceps were stained with hematoxylin–eosin and observed under light microscopy. Of the 85 cases of ischemic colitis (24 men and 61 women, average age 61.36 ± 14.49 years old, range 29–84), 71 were over 50 years of age. These cases were associated with the basal diseases such as hypertension, cardiovascular disorders, diabetes, and hematological diseases as well as a history of abdominal operation. The clinical features usually presented with sudden onset of abdominal pain, diarrhea, and hematochezia. Ischemic lesions were located mainly in the left colon with segmental form (only descending colon affected 16%, only splenic flexure 14%, and only sigmoid colon 23%). The 85 patients consisted of the non-gangrenous type (82), which were composed of reversible IC (76) and chronic IC (6), and the gangrenous type (3). Endoscopic appearance of the transient ischemic colitis consisted of petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement. Ischemic colitis of stricture was characterized by full-thickness mucosa, lumens stricture, and diseased haustrations. The mucosa of gangrenous colitis with cyanotic and pseudopolyps was endoscopically observed as well. Clinicopathologic characteristics showed mucosal inflammation accompanied by erosion, granulation tissue hyperplasia and gland atrophy, lamina propria hemorrhage, and macrophages with hemosiderin pigmentation in submucosa in particular. Although endoscopy findings and clinicopathologic characteristics of ischemic colitis are nonspecific, colonoscopy with biopsy plays a vital role in the early diagnosis of ischemic colitis.     

以便血为主要症状的缺血性结肠炎98例临床分析

目的 探讨急诊以便血为主要症状的缺血性肠炎（IC）患者的临床特点、内镜特征和诊治要点.方法 回顾性分析我院2001年1月～2011年9月经临床、结肠镜和病理确诊的98例缺血性结肠炎患者的相关资料,所有病例均在腹痛等症状出现后10天内行全结肠镜检查,76例（77.6％）取病变黏膜活检,观察其病理组织学特点.结果 本病好发于老年女性（年龄＞60岁）,男女之比为1∶2.8.81例（82.7％）伴有基础疾病,包括高血压、糖尿病、高脂血症、血液系统疾病等.临床表现绝大部分伴有腹痛（96.6％）,且以左侧多见（50.0％）.内镜检查发现病变部位主要在左半结肠,主要表现为结肠黏膜高度水肿、充血、出血、糜烂及溃疡.病理多为非特异性表现.绝大多数经过内科保守治疗好转,少数转为慢性.结论 对于老年女性患者出现急性便血伴有腹痛,合并有基础疾病的应首先考虑缺血性结肠炎的可能,应尽早行肠镜检查,明确诊断.     

缺血性结肠炎临床特点分析

目的分析缺血性结肠炎的临床资料,探讨其临床特点,提高对该疾病的认识和临床诊治水平。方法对31例缺血性结肠炎患者的临床表现、结肠镜检查、辅助检查、治疗经过以及转归等进行回顾性研究。结果缺血性结肠炎多发于老年患者,其中60岁者占54.8%(17/31)。多伴有高血压、冠心病、脑梗塞、糖尿病等基础疾病。腹痛、腹泻以及便血为主要临床表现。结肠镜下主要表现为黏膜充血、水肿、糜烂、溃疡,病变主要见于左半结肠,呈节段性分布,多数患者预后良好。结论缺血性结肠炎临床症状与体征缺乏特异性,对于不明原因出现腹痛、血便或腹膜刺激征的中老年人应考虑缺血性结肠炎的可能,充分运用相关辅助检查,以明确诊断,指导治疗。     

Outcome of patients with total colonic ischemia

PURPOSE: In this study, we sought to determine the outcome of patients with ischemic colitis, comparing patients with segmental disease with those with total colonic ischemia. METHODS: Patients with the diagnosis of ischemic colitis over the past six years were selected and reviewed for demographics, presenting symptoms, diagnosis, and treatment. RESULTS: Forty-three consecutive patients with ischemic colitis were identified and were grouped into those with segmentai ischemic colitis and total colonic ischemia. Mean age was 68.8 years; 28 of 43 patients (65 percent) were males. Diagnosis was established by colonoscopy in 31 of 43 patients (72 percent), whereas in the remainder, diagnosis was made in the operating room. Ischemic colitis developed in the hospital in 17 of 43 patients (40 percent) during admission for an unrelated illness. In 6 of 43 (14 percent) of these patients, ischemic colitis developed following surgery. Thirty-one of 43 patients (72 percent) were found to have segmental colitis; 11 of 31 patients (35 percent) were successfully managed nonoperatively. Segmental colitis was present in 31 of 43 patients (72 percent), and 12 of 31 (35 percent) of these patients were successfully managed nonoperatively. In the patients with segmental colitis who required surgery, the 30-day mortality rate was 22 percent. Among 12 of 17 patients (71 percent) with segmental ischemia treated by resection and stoma, 9 of 12 (75 percent) underwent eventual stoma closure. All 12 patients with total colonic ischemia required surgery, and 9 of 12 patients (75 percent) died. CONCLUSION: Ischemic colitis occurs commonly during an unrelated hospital admission and following previous surgery. Most patients treated by resection and stoma undergo stoma closure. Total colonic ischemia carries a worse prognosis than segmental colonic ischemia.     

Colonoscopy-induced ischemic colitis in patients without risk factors

Ischemic colitis is the most common form of intestinal ischemia.It is a condition that is commonly seen in the elderly and among individuals with risk factors for ischemia.Common predisposing conditions for ischemic colitis are major vascular occlusion,small vessel disorder,shock,some medications,colonic obstructions and hematologic disorders.Ischemic colitis following colonoscopy is rare.Here,we report two cases of ischemic colitis after a routine screening colonoscopy in patients without risk factors for ischemia.     

Reevaluation of Clinical Features of Ischemic Colitis Analysis of 68 Consecutive Cases Diagnosed by Early Colonoscopy

Background: Ischemic colitis (IC) is generally considered a disease of elderly patients who have associated diseases. The aim of the present study was to reevaluate the clinical features of IC. Methods: We retrospectively analyzed the clinical characteristics, background, and endoscopic and histologic changes in 68 consecutive patients (16 men and 52 women) with this disease diagnosed by early colonoscopy. Results: The patients' age ranged from 22 to 98 years (mean, 55 years). Twenty-three patients (34%, including 19 women) were less than 50 years of age. The classical predisposing factors were not discernible in patients younger than 50. Chronic constipation and prior history of abdominal surgery were common in both young and old patients. Early colonoscopy (especially by the 3rd day from onset) showed endoscopic and histologic findings consistent with the characteristics of IC. Conclusions: IC is not limited only to the elderly, and it should be considered in the differential diagnosis of colitis with melena in younger patients, especially females, who do not have any predisposing factors. Chronic constipation and prior history of abdominal surgery were commonly associated in both young and old patients. Early colonoscopy, especially by the 3rd day from the clinical onset, is essential for the accurate diagnosis of IC.     

以腹泻为主要表现的缺血性结肠炎12例诊治分析

目的 对缺乏典型临床表现的老年性缺血性结肠炎的诊治进行探讨。方法回顾分析1992年5月至2004年2月间共12例以腹泻为主要临床表现的缺血性结肠炎病人的临床经过、内镜表现及诊治。结果本组病人年龄均〉60岁，且多数伴有可能相关的基础疾病，包括心脑血管疾病、高血脂或腹腔手术史。初步诊断仅有4例考虑为缺血性结肠炎，其余拟诊为急性肠炎等疾病。10例（83．3％）依赖结肠镜检查确诊，其中早期肠镜检查6例。早期内镜表现主要为病变结肠黏膜充血、水肿、淤斑、糜烂、出血，严重者出现溃疡。病变黏膜与正常黏膜界限清楚。本组-过型11例（91．7％），经内科治疗后症状消失，狭窄型1例（8．3％）手术后恢复良好。结论老年性缺血性结肠炎可缺乏典型的临床表现，而仅以腹泻表现为主，此时容易发生漏诊，延误治疗。早期结肠镜检查对于正确诊断和及时治疗有重要价值。     

Evaluation of clinical features of ischemic colitis: Comparison between young and elderly

Background: It has been thought that ischemic colitis is caused by vascular and intestinal factors. Although elderly patients with arteriosclerosis are more susceptible to ischemic colitis, many young patients suffering ischemic colitis are also reported. The present study aimed to clarify the relationship between arteriosclerosis and ischemic colitis, and to evaluate various risk factors for ischemic colitis. Methods: We compared the clinical features of patients with ischemic colitis (54 cases) and control patients without ischemic colitis (86 cases), all diagnosed by colonoscopy. Subjects were classified into a young group (60 cases) under 60 years of age, and an elderly group (80 cases) of over 60 years. The degree of arteriosclerosis was measured by pulse wave velocity (PWV) level, and the effects of vascular and intestinal factors in the development of ischemic colitis were evaluated using multivariate analytical models. Results: In the elderly group, the PWV level was significantly higher in ischemic colitis patients than in the controls. By analyzing with multivariate analytical models, a high level of PWV and underlying diseases related to arteriosclerosis were thought to be risk factors for ischemic colitis in the elderly group. In the young group, intestinal factors such as irregular bowel movement, which is often seen in irritable bowel syndrome, habitual constipation, and prior history of an abdominal operation, were thought to be contributors to ischemic colitis. Conclusion: These findings suggest that intestinal factors in younger patients and vascular factors in more elderly patients are the primary contributors in the development of ischemic colitis.     

缺血性结肠炎临床特点分析

目的 探讨缺血性结肠炎的临床表现及内镜下特点以提高对本病的诊治水平.方法 回顾分析我院收治的37例缺血性结肠炎患者的临床资料及内镜下表现.结果 31例患者年龄大于50岁,29例伴有高血压病、心血管疾病、糖尿病、便秘、腹部手术等基础疾病.临床上主要表现为急性起病、腹痛、腹泻及便血.结肠镜下表现为黏膜充血、水肿、糜烂、溃...