大肠镜检查相关缺血性肠炎三例及文献复习

Literature Review and a Report of 3Patients with Ischemic Colitis Associated with Colonoscopy

目的分析大肠镜检查相关缺血性肠炎(IC)的发病原因、临床表现、内镜及病理表现,并制定预防措施。方法查阅国内外文献报道加本文病例大肠镜检查相关IC共21例,对病例资料进行综合分析。结果大肠镜检查相关IC均在大肠镜检查后3～24 h发病,临床表现为腹痛、腹泻、血水样便;D-二聚体正常或升高。内镜表现多为一过型。防治措施:检查过程中少注气,如注气过多及时抽气;操作时动作轻柔,钩拉时保持镜身的适当力度;紧张焦虑者选择静脉麻醉下检查;肠道准备时注意补充血容量;严格执行肠镜洗消制度。结论大肠镜检查可导致IC,应引起内镜医师的高度重视。对大肠镜检查相关IC者,应尽早行大肠镜检查确诊并及时治疗。

Objective To analyze causes, clinical manifestation, endoscopic and pathological findings of ische- mic colitis （IC） associated with colonoscopy, and to make preventive measures. Methods Clinical data of 21 patients with colonoscopy induced IC reported by domestic and foreign literature and the patients in this paper was comprehensive- ly analyzed. Results The onset of colonoscopy caused IC was within 3-24 h, and clinical manifestations were abdominal pain, diarrhea and bloody stool; D-dimer level was normal or elevated, and endoscopic characteristics was transient im- pairment type. Prevention measures： less insufflation, air exhaust should be performed in time if over insufflation; gentle movements, and keeping the hook to pull the appropriate dynamics should be done during the ＇colonoscopys procedure. Anxious patients should be examined under intravenous anesthesia; bowel preparation should be attention to supply blood volume; cleaning and disinfection of endoscope implements should be performed strictly. Conclusion Colonoscopy may lead to IC, so endoscopists should pay more attention to it. Patients with colonoscopy induced IC should be treated in colonoscopy as soon as possible to confirm the diagnosis and to treat in time.