老年人结肠血管畸形的临床和流行病学分析

目的 了解老年人结肠血管畸形（VM）的内镜特点、患病率及随访病情的变化。方法 经全结肠镜检查60岁以上老年人2917例，分为出血、无症状（无出血和其他消化道症状）和非出血（无出血但有其他消化道症状）3组，分析老年结肠血管畸形患者的结肠镜特点及老年人结肠血管畸形的患病率；对无症状和出血结肠血管畸形患者进行了3年随访，比较各组结肠血管畸形自发出血的风险。结果 老年人结肠血管畸形检出率为2．4％，显著高于非老年组的0．8％（P〈0．05）；无症状结肠血管畸形各组患者经3年随访无自发出血，但出血组均有自发再出血，且老年组（69．0％）显著高于非老年组（30．8％，P〈0．01）。结论 结肠血管畸形患病率老年组显著高于非老年组；老年和非老年无症状组结肠血管畸形自然转归良好，出血组再出血显著增多，应加强对出血结肠血管畸形患者的随访。

The study for colonoscopic manifestations and epidemiology in elderly patients with vascular malformation

ObjectiveTo investigate the colonoscopic manifestations, the prevalence and natural history of vascular malformation (VM) in elderly patients .MethodsTotally 2917 elderly patients were examined by colonoscopy and the colonoscopic apperances and prevalence were studied. A 3 years follow-up for VM patients was carried to assess bleeding risk. ResultsPrevalence in elderly group was 2.4%, while 0.8% for the non-elderly(P<0.01). No bleedings were occurred during the 3 years follow-up for asymptomatic VM cases, both in elderly and non-elderly patients,while the risk of rebleeding existed in the patients who had history of bleeding, and the rebleeding rate in elderly group was higher significantly than in non-elderly group((P<0.01).)ConclusionsThe VM prevalence rate is higher in the elderly than in the non-elderly (P<0.01). The natural history in asymptomatic VM patients is benign, but the risks of rebleeding over 3 year interval still exist in the patients having once suffered from colonic bleeding, especially in elderly patients. So the preventive colonscopic therapy may be indicated.