59例缺血性结肠炎临床研究

Clinical analysis of ischemic colitis

目的 了解缺血性肠炎的临床表现、内镜特点及其发病机理。方法 所有病例均于症状出现后１ ～１４ 天内行全结肠内镜检查，并于首次检查后两周至四个月内复查肠镜，部分病例取病变粘膜活检，观察其临床特征及内镜下表现特点。结果 经大肠镜检查确诊的５９ 例缺血性结肠炎、不包括两周内曾服用过抗生素者，男２０ 例，女３９ 例，年龄２５～８１ 岁，平均年龄５３－８６ 岁，其中１１ 例为４０ 岁以下的年青人，高峰年龄为６１ ～７０ 岁组，３６ 例患有动脉硬化相关性疾病，１１ 例无可以证明的基础病变，但其中的８ 例有便秘史，３ 例有下腹部手术史，２ 例发生于乙状结肠癌。大部分为一过性炎症型者。临床表现主要为腹痛、血便及腹泻，少数患者有呕吐或恶心：内镜下表现多样化，病变粘膜与正常粘膜界限清楚，多数病变位于左半结肠，无直肠病变者。病理表现无特异性。结论 缺血性结肠炎可以发生于各个年龄组，但以中年以上发病率为高，发病部位多位于血流相对不足的左半结肠，并易发生纤维狭窄。

Aim To observe the symptoms,colonoscopic features and mechanisms of the ischemic colitis.Method Colonoscopy was performed for all of the patients with ischemic colitis in 1 to 14 days after the symptom onset.And followed up in 2 weeks to 4 months after the first time of colonoscopy.Excluding antibiotics uptake in 2 weeks.Results Ischemic colitis was diagnosis by colonoscopy in 59 patients.They were 20 males and 39 females.Mean age was 53.86 years old.11 patients of them were under 40 years old.Peak age was at 7th decades.36 of all were patients with arterioschlerosis associated diseases.11 of 59 patients were healthy but 8 of them had the history of constipation.The most of symptoms were abdominal pain,bleeding per anal,diarrhea,vomit and nausia.Endoscopic finding were various,including bloody,edematous,mucosal necrosis,linear ulceration.The lesion has clear margin with normal mucosa.Most of lesions were seen at left colon which part was state of lower blood flow.Conclusion Ischemic colitis occurred in any decades but higher in elder patients with arterioschlerosis association diseases.Both vassles factors and intestine factors were important in pathogenesis of the ischemic colitis.