结肠黑变病76例的临床观察

Clinical analysis of melanosis coli in 76 cases

目的探讨结肠黑变病的临床特征、病因及防治。方法回顾性分析2006-2009年76例结肠黑变病的临床资料,重点对发病的性别差异、合并便秘情况、内镜检查和病理组织学情况进行分析。结果76例结肠黑变病中,女性发病率高于男性,中青年男性MC发病率低于老年男性,中青年女性MC发病率高于老年女性;便秘患者占86.84%,合并结肠息肉率26.32%。确诊前64例(84.21%)均长期或间断口服泻剂,12例(15.79%)未服用过泻剂。结肠镜可见结肠黏膜有黑褐色或棕褐色色素沉着。病理可见黏膜固有层巨噬细胞浸润,胞质内色素沉着。经治疗,部分MC可以逆转。结论结肠黑变病与便秘、长期服用泻剂和结肠息肉有关。治疗上应主要去除引起便秘的因素,使用促动力药、非蒽醌类泻剂。对长期服用蒽醌类泻剂的患者应定期结肠镜检查。对确诊的黑变病患者,应定期随访。结肠息肉和肿瘤应及早治疗。

Objective To investigate the clinical features,etiology,prevention and treatment of melanosis coli（MC）. Methods The clinieal data of 76 patients with melanosis eoli during 2006 -2009 were retrospectively analyzed. Results Among 76 patients, the morbidity of the female was higher than that of the male. The morbidity of the young and middle-aged male was lower than that of the old,while higher in the young and middle-aged female than in the old. In 76 patients with MC, the morbidity of constipation was 86.84%, and the morbidity of eolorectal polyps was 26.32%. Of 76 cases, 66 eases （84.21% ） taken laxative. Colonoscopy showed there was brown or brown-and-black pigmentation on the colonic mucosa. Pathological examination showed that in lamina propria of mueosa there were maerophages phagocytizing brown pigment. Some of MC were reversible after therapy. Conclusion MC is related to eonstipation, abuse of laxatives and eolorectal polyps. The treatment of MC should aim at constipation, and prokinetics or non-anthraqui none laxative should be used. Periodical eolonoseopy should be performed in the patients who take anthraquinone laxative. For the patients diagnosed as MC, periodical follow-up is necessary. For the patients with polyps or carcinoma, the active treatment should be carried on as early as possible.