缺血性结肠炎

本文简介了缺血性结肠炎病因、发病机制、临床诊断及治疗。提出老年人突发腹痛、便血、腹泻三主征要首先考虑缺血性结肠炎的可能,早期结肠镜检查是诊断本病的首选方法,对于提高临床医师对缺血性结肠炎的认识很有帮助。     

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.     

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.     

缺血性结肠炎诊治现状

缺血性结肠炎(ischemic colitis,IC)是缺血性肠病中最常见的类型,也是下消化道出血的常见原因之一,由于肠道血流不能满足代谢需要导致大肠的特定肠段非感染性的炎症。IC病因多样,小血管病变、休克导致的全身血流灌注不足、缩血管药物的使用、腹部血管手术、便秘等可导致IC。老年人高发,临床表现无特异性,多数患者表现为急性的痉挛性腹痛、腹泻、排便急迫感和便血。结肠镜及活检病理检查在早期诊断中具有重要地位。大多数患者为一过性的非坏疽型的缺血,经内科保守治疗即可痊愈。但部分患者重度缺血出现结肠全层坏死、穿孔甚至多脏器功能衰竭。     

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17例临床资料分析

[目的]分析缺血性结肠炎(IC)的临床特征,以提高临床诊疗水平。[方法]收集17例IC患者的病例资料,对其年龄、基础疾病、临床表现、实验室检查、镜下表现及治疗等方面进行回顾性分析。[结果]IC多发生于有心脑血管疾病史的中老年女性,以腹痛、便血为主要表现,病变多位于结肠脾曲、降结肠、乙状结肠。[结论]对于有心脑血管等基础疾病的中老年患者出现不明原因的腹痛、便血时需警惕IC可能,应及时行结肠镜检查,及早进行治疗。     

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.     

老年人缺血性结肠炎的临床分析

目的：总结老年人缺血性结肠炎的临床特点，探讨早期诊断方法。方法：收集分析了1975年6月至2001年8月经结肠镜发现、病理确诊的缺血性结肠炎39例的相关临床资料，按年龄是否大于60岁分为老年组29例与非老年组10例，进行对比分析，所有病例均在腹痛等症状出现后5天内行全结肠内镜及病理检查，大多于治疗后2周至2个月内复查结肠镜，部分病例取病变粘膜活检，观察其内镜下表现及临床特点。结果：老年组与非老年组的临床主要表现均为腹痛、血便及腹泻等，本组病变多数位于左半结肠。老年组一过性炎症型有24例，狭窄型有4例，仅有1例坏疽型。而非老年组一过性炎症有9例，狭窄型有1例，无坏疽型。两组的病理学表现无特异性。结论：早期行结肠镜检及病理组织学检查是诊断老年人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36例临床分析

背景：缺血性结肠炎（IC）在国外报道较多，国内报道较少，近年来有增多的趋势，但对IC临床特点的认识尚有限。目的：总结IC的临床特点和诊断方法，提高对该病的认识和治疗水平。方法：回顾性分析2002年9月～2007年2月期间浙江中医药大学附属第一医院消化内科确诊为IC患者的临床资料，详细记录每位患者的病史、临床症状、结肠镜下表现、病理检查、诊治经过和转归，并进行总结。结果：IC患者共36例，男女之比为1：3．5，50岁以上患者占91．7％，且多数（91．7％）伴有相关的基础疾病；临床上多以腹痛（75．0％）、血便（91．7％）为首发表现，其中鲜血便占57．6％；腹部体征有压痛者占55．6％，其中80％与病变部位相关。36例均行电子结肠镜检查，病变部位多位于乙状结肠（63．9％）和降结肠（52．8％）。均予扩血管和内科综合治疗，22例痊愈、14例好转，平均痊愈或好转时间为12d。结论：IC好发于老年女性，多急性发作，其典型表现为急性腹痛和便血，辅助检查可首选结肠镜，早期诊断为治疗的关键，及时扩血管治疗大多预后良好，病程较短，恢复较快。     

缺血性结肠炎的结肠镜及影像学检查特征分析

[目的]分析缺血性结肠炎的结肠镜及影像学检查特征。[方法]回顾性分析96例缺血性结肠炎患者的临床资料。[结果]结肠镜检查以脾曲、降结肠及乙状结肠为最易受累部位,大多表现为一过型。腹部CT检查以病变肠段的肠管壁增厚为主要表现,腹主动脉或肠系膜动脉硬化及斑块形成检出率(14.3%)远低于腹部血管B超检查(73.3%),二者比较差异有统计学意义(χ²=51.3,P<0.01);右半结肠缺血患者住院日[(13.3±5.7)d]较无右半结肠缺血患者住院日[(9.5±3.4)d]更长,二者比较差异有统计学意义(t=-3.1,P<0.001)。[结论]临床工作中,尽早进行结肠镜、腹部CT及腹部B超等相关检查有助于早期诊断和治疗缺血性结肠炎,改善预后。     

缺血性结肠炎30例临床分析

目的：探讨缺血性结肠炎的临床特征、内镜表现及治疗,以提高对该病的认识和临床诊治水平。方法对30例缺血性结肠炎患者的临床资料进行回顾性分析。结果30例患者中男6例、女24例,年龄42～83岁。73．3％（22/30）既往有一项或几项基础疾病,有高血压11例、冠心病4例、糖尿病2例。27例出现腹痛,28例出现便血症状,6例出现腹泻,12例出现恶心呕吐。6例腹部CT检查显示肠管异常。结肠镜检查发现病变累及降结肠18例,乙状结肠24例,横结肠、降结肠6例,降结肠、乙状结肠13例;镜下病变多呈节段性分布,表现为不同程度黏膜充血水肿、斑片状糜烂及不规则浅表溃疡形成、黏膜血管网消失,病变黏膜与正常黏膜分界清楚。病理组织学检查显示,黏膜多水肿,毛细血管扩张充血,间质内中性粒细胞浸润,黏膜下出血;当病程较长时部分可见炎性肉芽肿形成。结论缺血性结肠炎好发于女性,尤其是伴有糖尿病、高血压等基础疾病者。腹痛、腹泻及便血为主要临床表现。内镜检查病变多位于左半结肠,呈节段性分布,一过型,黏膜充血、水肿、糜烂为主要表现。多数患者预后良好。     

Mechanism of diarrhea in microscopic colitis

AIM: To search the pathophysiological mechanism of diarrhea based on daily stool weights, fecal electrolytes, osmotic gap and pH. METHODS: Seventy-six patients were included: 51 with microscopic colitis (MC) [40 with lymphocytic colitis (LC); 11 with collagenous colitis (CC)]; 7 with MC without diarrhea and 18 as a control group (CG). They collected stool for 3 d. Sodium and potassium concentration were determined by flame photometry and chloride concentration by titration method of Schales. Fecal osmotic gap was calculated from the difference of osmolarity of fecal fluid and double sum of sodium and potassium concentration. RESULTS: Fecal fluid sodium concentration was significantly increased in LC 58.11±5.38 mmol/L (P<0.01) and CC 54.14±8.42 mmol/L (P＜0.05) than in CG 34.28±2.98 mmol/L. Potassium concentration in LC 74.65±5.29 mmol/L (P<0.01) and CC 75.53±8.78 mmol/L (P<0.05) was significantly less compared to CG 92.67±2.99 mmol/L. Chloride concentration in CC 36.07±7.29 mmol/L was significantly higher than in CG 24.11±2.05 mmol/L (P<0.05). Forty-four (86.7%) patients had a secretory diarrhea compared to fecal osmotic gap. Seven (13.3%) patients had osmotic diarrhea. CONCLUSION: Diarrhea in MC mostly belongs to the secretory type. The major pathophysiological mechanism in LC could be explained by a decrease of active sodium absorption. In CC, decreased CI/HCO_3 exchange rate and increased chloride secretion are coexistent pathways.     

脂微球前列腺素E1治疗缺血性结肠炎的研究

目的研究脂微球前列腺素E1（Lipo-PGE，）对大鼠缺血性结肠炎（IC）治疗作用，并探讨其治疗机制。方法用光化学法建立大鼠IC模型，观察不同剂量Lipo-PGE，（0．5，1，2μg／kg，静滴，给药5d）治疗后结肠黏膜损伤指数（LI）、过氧化物歧化酶（SOD）、丙二醛（MDA）、6-酮-前列腺素F1α（6-keto-PGF1α）、血栓素B2（TXB2）及6-keto-PGF1α/TXB2（P／T）的变化，分析肿瘤坏死因子α（TNF-α）、细胞间黏附分子1（ICAM-1）在结肠组织的表达情况。结果与生理氯化钠溶液阴性对照组比较，1μg／kg和2μg／kg组LI均显著降低，SOD、P／T显著升高，而MDA和TxB2含量及TNF-a和ICAM-1的阳性细胞数均显著降低。结论Lipo-PGE，对IC有较好的治疗效果，可以减轻结肠损伤。治疗机制可能主要与抑制血栓形成、改善组织微循环、减轻炎症反应及氧自由基的产生有关。     

Diagnosis and management of microscopic colitis

Microscopic colitis, comprising collagenous and lymphocytic colitis, is characterized clinically by chronic watery diarrhea, and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscoplc incidence of each disorder examination. The annual is 4-6/100000 inhabitants, with a peak incidence in 60-70-year-old individuals and a noticeable female predominance for collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue and fecal incontinence are common symptoms, which impair the health-related quality of life of the patient. There is an association with other autoimmune disorders such as celiac disease, diabetes mellitus, thyroid disorders and arthritis. Budesonide is the best-documented shortterm treatment, but the optimal long-term strategy needs further study. The long-term prognosis is good and the risk of complications including colonic cancer is low.     

Clinical and endoscopic features of ischemic colitis

OBJECTIVE: To review the clinical and endoscopic features, and outcome of ischemic colitis. METHODS: Sixty cases with the diagnosis of ischemic colitis were retrospectively analyzed. All the patients were under observation in hospital and most of them underwent colonoscopy at least twice: once for diagnosis and then follow‐up after treatment. The demographic data, presenting symptoms, endoscopic findings, laboratory tests, and treatment were reviewed. RESULTS: Fifty‐two of the 60 cases were over 50 years old (87%; mean age, 59.9 years): 40 female, 20 male (2 : 1); 76.0% of these patients had a coexistent disease such as a cardio‐cerebrovascular disorder, diabetes, hematologic diseases or a previous history of abdominal surgery. Abdominal pain (57/60, 95%), hematochezia (55/60, 91.7%), and diarrhea (26/60, 43.3%) were the main complaints. Lesions seen on colonoscopy were more commonly located in the left colon (46/60, 79.3%) and rectum (5/60, 8.6%), and were characteristically segment‐distributed, including hemorrhagic edematous mucosa, erosions, ulcerations, pseudopolyps, and stricture. Ultrasonography revealed colonic wall thickening in 13 cases (13/55, 21.7%), and small to moderate ascites was detected in 4 cases (4/55, 7.3%). In this cohort, most of the patients recovered (49/60, 81.7%) or improved (10/60, 16.7%) after conservative treatment. Only one patient who had a myocardial infarction prior to the onset of the ischemic colitis, died from peritonitis complicated with septic shock. Progress and outcome were associated with the patient's age, severity of the lesions, clinical course, underlying diseases and the complications. CONCLUSION: Colonoscopy is safe and helpful in the early diagnosis of ischemic colitis. Nongangrenous colonic ischemia usually requires only medical management and is associated with a good prognosis.     

Epidemic enterocolitis possibly as a result of Norwalk virus infection presenting as ischemic colitis

Ischemic colitis usually presents as an isolated event, and clustering seldom occurs. Although a majority of instances of colonic ischemia have no clearly identifiable cause, many kinds of predisposing factors for the occurrence of ischemic colitis are pointed out. These include high age, generalized atherosclerosis, impaired cardiac function, hypovolemia, hypotension, colonoscopy, obstructing colonic cancer, coagulopathies and use of vasoconstrictors or contraceptives. However, infectious viral enterocolitis has not been regarded as a predisposing factor for colonic ischemia. We present here two cases of epidemic enterocolitis presenting as ischemic colitis that occurred almost simultaneously in two compromized long‐term patients in Noda Hospital, Chiba Prefecture. At the time, viral enterocolitis due to Norwalk virus infection was epidemic in Japan, including in the region of the hospital. It is likely that epidemic enterocolitis induced strong gut peristalsis and caused colonic spasm that mediated colonic ischemia. Indeed, both patients were elderly and had prominent signs of atherosclerosis, and one patient suffered from diabetes mellitus. Notably, the physician who performed the rectosigmoidoscopy in the two patients presented with enterocolitis 1 day after the procedure. This indicates that occupational transmission of epidemic enterocolitis can occur in medical staff during endoscopy procedures.