缺血性结肠炎30例临床分析

摘要

Objective To investigate the clinical feature, endoscopic performance and therapy of ischemic colitis in order to improve the level of awareness and treatment.Methods The clinical data of 30 patients with ischemic colitis were analysed by retrospective analysis.Results Among all the thirty patients, 6 were male and 24 were female.They were aged from 42 to 83 years old.73.3%of the patients had one or more basic diseases.11 cases were accompanied with hy-pertension, 4 cases suffered from coronary heart disease and 2 cases had diabetes.27 cases got abdominal pain, 28 cases had hematochezia, 6 cases had diarrhea and 12 cases had nausea or vomited.6 cases had abnormal guts examined with ab-dominal CT.With the help of colonoscopy, it showed that the disorder affected 18 cases′decending colon, 24 cases′sig-moid colon, 6 cases′transverse and decending colon, and 13 cases′descending and sigmoid colon.The lesions were in segmental distribution, showing different degrees of damage, like mucosal congestion and edema, patchy erosion, irregular superficial ulcer and the disappearance of mucosal vessels.There were clear boundaries between normal and abnormal mu-cous membrane.Histologic examination showed mucosal edema, congestion, neutral lymphocyte infiltration and submucosal hemorrhage.As the progression of the disease, some formed inflammatory granuloma.Conclusions Ischemic colitis often occurs in women, especially with diabetes, hypertension and other underlying diseases.Abdominal pain, diarrhea and he-matochezia are the main clinical manifestations of the disease.Endoscopic examination reveales that lesions were mainly lo-cated in the left colon, which distribute segmentally and belonge to a transient type.Mucosal congestion, edema, erosion are the main pathological performance of ischemic colitis.The majority of patients′prognosis are good.%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。