伴有慢性便秘的老年缺血性结肠炎的临床特点

目的对伴有便秘的老年缺血性结肠炎（IC）患者的临床特点进行总结，旨在更好地指导临床工作，减少误诊、漏诊。方法回顾性地分析复旦大学附属华东医院消化内科2008年至2013年收治的160例老年IC患者，其中男35例，女125例，根据有无便秘分为便秘组和非便秘组，比较两组IC患者的基础疾病、临床表现、误诊情况、实验室检查、内镜和病理组织学检查结果，以及诊治经过及疾病转归等。结果160例IC患者中，便秘患者占57．5％；便秘组发病年龄低于非便秘组；临床表现不典型；误诊率高（48．8％）；病变程度较重；治疗2周后黏膜完全愈合率63.0％低于非便秘组79．9％。便秘组中78．3％的患者病变位于左半结肠与非便秘组75．0％相仿。结论慢性便秘在老年IC中常见，是老年IC发病的重要危险因素。伴有慢性便秘的老年IC患者临床表现不典型，当慢性便秘患者存在其他危险因素如高血压、冠心病、糖尿病等，一旦出现腹痛或便血时应高度警惕IC发生，应尽早行肠镜检查，明确诊断。

Clinical characteristics of ischemic colitis in elderly accompanied with chronic constipation

Objective To summarize the clinical characteristics of the elderly ischemic colitis （IC） with constipation in order either to better instruct clinical practice or to avoid rnisdiagnosis or missed diagnosis. Methods A total of 160 elderly 1C patients （35 males and 125 females） hospitalized in our department from 2008 to 2013 were observed and retrospectively analyzed. According to the presence of constipation, the 160 patients were divided into 2 groups： constipation group and non-constipation group. The underlying conditions, clinical manifestations, misdiagnosis, laboratory examination results, endoscopic findings, pathological observation, clinical course, and outcomes after treatment were analyzed and compared between the 2 groups. Results There were 92 patients out of 160 IC （57.5%） suffering from constipation. Compared with the IC patients without constipation, those with constipation were younger, and had atypical clinical manifestations, higher misdiagnosis rate （48.8%）, and worse colonic lesions. After 2-week treatment, the rate of complete mucosal healing was lower in the patients with constipation than those without （63.0% vs 79.9%）. The bowel lesions in the left colon accounted for 78.3% in the patients with constipation, and 75.0% in those without, and the amount was similar between the 2 groups. Conclusion Chronic constipation is quite common in the elderly IC patients, and is also an important risk factor for IC. The patients of IC with chronic constipation usually have atypical clinical manifestations. For the chronic constipation patients accompanied with multiple comorbid diseases, such as hypertension, coronary heart disease and/or diabetes, strong vigilance should be paid for their abdominal pain or hematochezia, and colonoscopy should be performed as early as possible to make correct diagnosis.