以便血为主要症状的缺血性结肠炎98例临床分析

Clinical analysis of 98 cases of ischemic colitis with hematochezia as cardinal symptom in emergency

目的 探讨急诊以便血为主要症状的缺血性肠炎（IC）患者的临床特点、内镜特征和诊治要点.方法 回顾性分析我院2001年1月～2011年9月经临床、结肠镜和病理确诊的98例缺血性结肠炎患者的相关资料,所有病例均在腹痛等症状出现后10天内行全结肠镜检查,76例（77.6％）取病变黏膜活检,观察其病理组织学特点.结果 本病好发于老年女性（年龄＞60岁）,男女之比为1∶2.8.81例（82.7％）伴有基础疾病,包括高血压、糖尿病、高脂血症、血液系统疾病等.临床表现绝大部分伴有腹痛（96.6％）,且以左侧多见（50.0％）.内镜检查发现病变部位主要在左半结肠,主要表现为结肠黏膜高度水肿、充血、出血、糜烂及溃疡.病理多为非特异性表现.绝大多数经过内科保守治疗好转,少数转为慢性.结论 对于老年女性患者出现急性便血伴有腹痛,合并有基础疾病的应首先考虑缺血性结肠炎的可能,应尽早行肠镜检查,明确诊断.

Objective To summarize the clinical characteristics, endoscopic characteristics and treatment point of ischemic colitics, whose emergency symptoms is hematochezia. Methods 98 patients were selected from January 2001 to September 2011 who with ischemic colitis according to colonoscopy and pathology clinical diagnosis. All the patients had on colonoscopy within 10 days after they had the ab- dominal pain symptoms. And 76 cases（77.6% ） were taken to observe the pathological biopsy,histopatho- logical characteristics. Results Ischemic colitis disease often occurs in older women （ age 〉 60 years old）. The ratio of the men and women who had this disease is 1 ： 2.8. Within these cases 81 cases （82.7%） with underlying diseases,these underlying diseases including high blood pressure,diabetes,hy- perlipidemia, blood diseases, etc. Most of the clinical manifestations accompanied by abdominal pain （96.6%） ,the abdominal pain was mostly occurred at left parts of the body（50.0% ）. Endoscopic exami- nation showed the lesions is mainly at left colon, the mainly performance are Colonic mucosa edema, con- gestion,haemorrhage, erosion and ulcer. Most pathology is nonspecific performance. Most of the patients will be get better after medical therapy get better, some of the patients＇ disease will become chronic. Con- clusion For the old woman patients with acute abdominal pain and hematochezia associated with basic diseases. The treatment should be firstly consider the possibility of ischemic colitis and examine enterosco- py. The treatment should be definitive diagnosis, avoid delay treatment.