左半结肠缺血性结肠炎早期电子结肠镜检查的意义

The diagnostic value of the early colonoscopy for left hemicolon ischemic colitis

目的探讨左半结肠缺血性结肠炎早期电子结肠镜检查的意义及临床病理学特征。方法对发病72小时内进行早期电子结肠镜检查确诊的32例左半结肠缺血性结肠炎患者资料进行回顾性分析。结果全部急性起病,突发腹部疼痛93.8%,多为轻中度阵发性左中下腹绞痛,腹痛后出现血便者81.3%,腹泻65.6%,发热15.6%,腹胀34.4%。结肠镜下分型:一过型68.8%,狭窄型25.0%,坏死型6.2%。以乙状结肠及结肠脾曲受累为主。内镜下表现以靠近肠系膜一侧的黏膜淤点性出血、水肿、散在糜烂、节片性红斑、纵向溃疡为主,病变部位与正常黏膜界限清楚。结论对怀疑左半结肠缺血性结肠炎的患者,在发病早期行电子结肠镜检查对于疾病的诊断和鉴别以及指导治疗有重要的临床意义。

Objective To evaluate the diagnostic value of early colonoscopy tor lett henucolon ischennc colitis and to summarize the clinicopathologic characteristics. Methods 32 cases of left hemieolon ischemic colitis, who underwent early colonoscopy in 72 hours from onset hetween March 2005 and March 2009, were retrospectively studied. Results The 32 patients all showed acute onset, with symptoms of sudden left middle and inferior abdominal pain 93.8%, bloody stools 81.3%, diarrhea 65.6%, fever 15.6% and ＇abdominal distension 34.4%. Their ischemic lesions were located mainly in the sigmoid colon 53.1% and splenic flexure 50. 0%. The clinical transient type in 22 patients , stricture type in 8 and gangrenous type in 2. Endoscopy detected petechial hemorrhages, edematous and fragile mucosa, segmental erythema, scattered erosion, longitudinal ulcerations, and sharply defined segment of involvement. Conclusion Electronic colonoscopy are necessary feasible to establish the diagnosis of ischemic colitis. Specially, early colonoscopy within 72h of onset plays a vital role in the early diagnosis and treatment of ischemic colitis in left hemicolon.