老年缺血性结肠炎的内镜及临床特点

Endoscopic and clinical features of ischemic colitis in elderly patients

目的总结老年缺血性结肠炎患者的内镜及临床特点，探讨其早期诊断方法。方法收集分析2000年1月～2007年12月，经临床、结肠镜确诊的老年缺血性结肠炎患者的相关资料，89例患者均在腹痛等症状出现后10天内行全结肠镜检查，部分病例取病变黏膜活检，观察其内镜下表现及病理组织学特点。结果经临床、结肠镜确诊为老年缺血性结肠炎者90例，其中男25例、女65例，男女之比为1：2．6，年龄为60～90岁，平均年龄（73．31±6．63）岁，多伴有相关基础疾病。临床主要表现为腹痛和血便，病变多数位于左半结肠。一过型者86例，狭窄型4例，无坏疽型。病理学表现无特异性。结论老年病人出现急性腹痛、便血时，及时结肠镜检查对明确缺血性结肠炎诊断，了解病变范围和分犁具有重要意义。

Objective To evaluate clinical and endoscopic characteristics of ischemxc coitus （ITS）, and explore methods for early diagnosis. Methods All elderly patients diagnosed with IC in Huadong Hospital from January 2000 to December 2007 were reviewed retrospectively. All patients underwent colonoscopy within 10 days of symptom onset, and some patients were biopsied during colonoscopy. Results All 90 elderly patients （25 men and 65 women; range 60-90 years, mean 73.31 ±6.63） who were diagnosed with IC both clinically and colonoscopically were complicated with some underlying diseases. IC usually presented with sudden onset of left lower quadrant abdominal pain and hematochezia. Most ischemic lesions were in the left colon, including transient or reversible colitis in 86 cases and stricture colitis in 4 cases. No gangrene colitis was found. Pathologic changes varied with the duration and severity of the condition. Conclusions Ischemic colitis should be suspected in elderly patients with acute onset of abdominal pain and bloody diarrhea. Early colonoscopy is the main method for the diagnosis of IC.