老年人缺血性肠炎56例临床分析

目的 探讨老年人缺血性结肠炎（IC）的临床及内镜特征、病理特征及危险因素,减少该病的误诊.方法 对56例IC患者的临床资料进行回顾性分析,根据发病年龄分为老年组（〉60岁）和对照组（〈60岁）,比较两组患者的基础疾病、临床特征、内镜和病理学检查结果等.结果 高血压、冠心病等是本病的主要危险因素,IC常见的症状有腹痛、下消化道出血、腹泻腹胀等.老年组患者基础疾病较多、误诊率高、并发症多（P〈0.05）.IC好发于降结肠及乙状结肠,内镜下见病变区黏膜充血水肿、糜烂、出血及溃疡形成,病理表现为黏膜炎症,肉芽组织增生,腺体萎缩,固有层出血等.结论 老年人IC缺乏特异性的临床表现,基础病史有助于IC的诊断,早期行结肠镜检是诊断IC的重要方法,有助于临床医师提高对IC的诊治,减少误诊.

Objective To explore the clinical, endoscopic and pathological characteristic, and risk factors of elderly ischemic colitis （IC） and to reduce the misdiagnose of IC. Methods By retrospective analysis of the clinical data of 56 cases of IC in the First Affiliated Hospital of Soochow University, two groups including the elderly group （more than 60 years old） and the control group （less than 60 years old ） were divided according to age and were analyzed of the past medical history （PMH）, clinical characteristic, and the endoscopic and pathological resuks. Results It showed that hypertension and coronary heart disease were the major risk factors of IC. The common symptoms of IC included abdominal pain, bleeding of inferior digestive tract, diarrhea, and abdominal distention and so on. Furthermore, the elderly group had more PMH, higher misdiagnose, and more complications （P 〈 0. 05 ）. IC occurred frequently in desecnding colon and sigmoid colon. Hyperemia, edema, erosion, bleeding and ulcer in the mucous membrane of diseased regions were observed in endoscopic analysis. The pathological characteristic included inflammation of mucous membrane, hyperplasia of granuloma, atrophy of gland, and bleeding of lamina propia. Conclusions There is little specific clinical manifestation in elderly IC. The PMH is helpful for the diagnosis of IC and the early endoscopic colon detection is an important method in diagnosis, which is helpful to improve the levels of diagnosis and treatment for clinician with less misdiagnosis.