缺血性结肠炎26例临床分析

Clinical Analysis of 26 cases of ischemic colitis

目的探讨缺血性结肠炎的诱发因素、临床特点,以降低对该病的误诊、漏诊率。方法分析我院2006年1月—2010年9月经肠镜确诊缺血性结肠炎的26例患者的临床特点。结果本组26例患者中88%年龄>60岁,平均67.4岁。均存在一定的诱发因素,如原发性高血压、冠心病、高脂血症、糖尿病、脑梗死、便秘、心梗冠脉搭桥术后、慢性阻塞性肺病(COPD)、结肠癌术后等。该病早期症状不典型,误诊率达76.92%,其中2例慢性腹痛病例误诊时间20 d。肠镜检查发现本组26例中20例发生在乙状结肠及降结肠,无1例累及全结肠,直肠未见发病。确诊后采取恰当的治疗措施,大部分病例症状很快消失,病变恢复快,死亡率仅占3.85%。结论 缺血性结肠炎多发生于中老年人,尤其对存在易感因素的高危人群,出现不明原因腹痛、呕吐、腹泻、血便或黏液血便,应考虑缺血性结肠炎发生的可能,及早进行肠镜等检查是防止误诊、漏诊的关键。

Objective To analyze the induced factors and clinical characteristics of ischemic colitis,reduce the disease misdiagnosis rate.Methods Clinical data of 26 patients with ischemic colitis diagnosed by colonoscopy in our hospital from January 2006 to September 2010 were analyzed retrospectively.Results 88% of this group of 26 patients aged over 60 years,average 67.4 years old.There were certain predisposing factors,of which patients had primary hypertension,coronary artery disease,hyperlipidemia,diabetes,cerebral infarction and constipation.There was myocardial infarction after coronary artery bypass graft,chronic obstructive pulmonary disease（COPD）,colon cancer and other factors.Early symptoms are not typical of the disease;misdiagnosis rate was 76.92%,of which 2 cases of misdiagnosed cases of chronic abdominal pain,the time up to 20 days.Colonoscopy found that 76.92% of the 26 cases occurred in the sigmoid colon and descending colon,no case involving the entire colon,rectum no disease.Appropriate treatment after diagnosis to take measures,in most cases the symptoms disappear quickly,disease rapid recovery,the mortality rate only 3.85%.Conclusion Ischemic colitis often occurred in the elderly,in particular,the existence of predisposing factors of high-risk groups.Unexplained abdominal pain,vomiting,diarrhea,bloody or mucous bloody stool,you should consider the possible occurrence of ischemic colitis,early colonoscopy and other tests,which is the key to prevent misdiagnosis.