以腹泻为主要表现的缺血性结肠炎12例诊治分析

Diagnosis and treatment of ischemic colitis with diarrhea as the main symptom:report of twelve cases

目的对缺乏典型临床表现的老年性缺血性结肠炎的诊治进行探讨。方法回顾分析1992年5月至2004年2月间共12例以腹泻为主要临床表现的缺血性结肠炎病人的临床经过、内镜表现及诊治。结果本组病人年龄均>60岁,且多数伴有可能相关的基础疾病,包括心脑血管疾病、高血脂或腹腔手术史。初步诊断仅有4 例考虑为缺血性结肠炎,其余拟诊为急性肠炎等疾病。10例(83．3％)依赖结肠镜检查确诊,其中早期肠镜检查6 例。早期内镜表现主要为病变结肠黏膜充血、水肿、淤斑、糜烂、出血,严重者出现溃疡。病变黏膜与正常黏膜界限清楚。本组一过型11例(91．7％),经内科治疗后症状消失,狭窄型1例(8．3％)手术后恢复良好。结论老年性缺血性结肠炎可缺乏典型的临床表现,而仅以腹泻表现为主,此时容易发生漏诊,延误治疗。早期结肠镜检查对于正确诊断和及时治疗有重要价值。

Objective To explore the diagnosis and treatment for the elderly who had no typical characters of ischemic colitis（IC）. Methods Twelve aged patients with IC whose main clinical symptom was diarrhea from 1992.5 - 2004. 2 were reviewed and their symptoms, signs and colonoscopic features were analyzed. Results All the patients were above 60 years old. Most of them had cardiopathy or cerebrovascular diseases, hyperlipemia, history of abdominal operations, etc. Only 4 persons were diagnosed as IC at first, while the others were considered to have other diseases such as acute enteritis. Ten patients were diagnosis by colonoscopy and 6 of them received colonoscopy early. Colonoscopic findings were various, including congestion, edema, petechia, erosion, hemorrhage and ulcer of mucous membrane. The lesions were limited to the abnormal mucosa. Eleven patients of transient type were given medical treatment and one constrictive type case was treated with operation. All recovered well after treatment. Conclusion IC in elderly patients can have no typical symptoms except diarrhea, leading to missed diagnosis easily. Early colonoscopy is important to diagnosis and cure of IC.