缺血性结肠炎63例临床分析

目的 总结缺血性结肠炎(ischemic colitis,IC)患者的临床特征、内镜表现、诊断及治疗方法.方法 对63例患者的临床症状、易患因素、体征、结肠镜检查资料进行回顾性分析.结果 IC好发于50岁以上中老年人,占87.3%(55/63);主要临床表现为急性下腹痛以及便血;易患因素提示病变主要发生在高血压、冠心病、糖尿病等人群;内镜分型均为非坏疽性,未发现坏疽性缺血性结肠炎;内镜下病变肠段与正常肠段分界较明显,表现为黏膜充血、水肿,黏膜下红斑,点状糜烂及浅溃疡,多呈纵行或不规则形.2周后59例复查结肠镜患者病变54例(91.5%)痊愈;5例(5/59,8.5%)患者病变明显减轻,有黏膜红斑,轻度充血、水肿;2例(3.1%)出现肠腔局部狭窄4例肠镜后缺血性结肠炎患者症状缓解,未复查肠镜;无死亡病例.结论 中老年患者出现急性下腹痛和便血时应警惕IC的可能,及早内镜检查是明确诊断、了解病变范围及程度、判断预后的主要手段.

Clinical analysis of 63 cases of ischemic colitis

To summarize the clinical features,endoscopic manifestations,diagnosis and treatment of ischemic colitis（IC）. We retrospectively analyzed the clinical symptoms,suspected etiological factors,signs and endoscopic results of 63 patients. IC was likely to occur in patients over 50 years old（87.3%,55/63）,with main clinical symptoms as acute lower abdominal pain and hematochezia.Hypertension,coronary heart disease and diabetes might be the main etiological factors.All the cases were classified endoscopically as non-gangrenous IC.The dividing line between lesion and the normal intestine segments was clear under endoscope.The manifestations of the lesion intestine segment included mucosal erythema,edema,submucosal erythema,punctiform erosion,and superficial ulcer which represented as longitudinal or irregular shape.Fifty-one（52/59,88.1%） of the 59 patients reexamined by colonoscopy two weeks later completely recovered.Five patients（5/59,8.5%） obviously recovered,still with mucosal erythema,mild hyperemia and edema.Focal colonic stricture occurred in 2 patients（3.1%）.Four patients did not undergo reexamination because of symptomatic relief after the first colonoscopy.No death ever occurred. Acute lower abdominal pain and hematochezia serve as alarming signs of possible IC for elderly patients who then should receive timely colonoscopy which is proved to be an essential approach for diagnosing and evaluating the extent and degree of disease and predicting of prognosis.