慢性假性肠梗阻的临床特征和诊断

Clinical characteristics and diagnosis of chronic intestinal pseudo-obstruction

目的 分析慢性假性肠梗阻 (CIP)的临床特征和诊断方法。方法 对北京协和医院1978年 11月至 2 0 0 0年 12月诊断的 2 3例CIP的临床资料进行了分析 ,并结合文献 ,总结CIP的临床特征和诊断方法。结果 2 3例CIP患者中男性 9例 ,女性 14例 ,年龄 4～ 75岁 (中位数 5 0岁 )。主要症状有腹胀 ( 87%)、腹痛 ( 5 7%)、腹泻 ( 65 %)、便秘 ( 4 8%)、呕吐 ( 3 9%)和体重下降 ( 83 %)。CIP患者腹胀突出而腹痛相对较轻 ,伴有腹泻、体重明显下降和消化道其他部位动力的异常 ;很少出现机械性肠梗阻的体征 ;腹部平片除存在液气平面 ( 17/ 2 0 ,85 %)外 ,可见肠管普遍扩张和结肠积气 ( 13 / 2 0 ,65 %) ;消化道钡剂造影显示肠管明显扩张 ( 19/ 2 3 ,83 %) ,肠蠕动减慢和消失 ( 17/ 2 3 ,74 %) ;有关检查或 (和 )手术探查均未发现机械性肠梗阻的证据。病变主要累及小肠 ( 83 %)和结肠 ( 3 9%)。 18例为慢性特发性假性肠梗阻 ,其中 1例为家族性内脏肌病 ,5例继发于结缔组织病。结论 CIP的临床表现具有一定的特征性 ,凭借腹部平片的特点 ,有针对性地选择消化道钡剂造影 ,结合胃肠道动力检查的异常发现可对CIP做出正确诊断。

Objective To analyze and determine the clinical characteristics and diagnostic methods of chronic intestinal pseudo-obstruction(CIP). Methods We reviewed the medical records of all 23 patients who diagnosed with CIP in Peking Union Medical College Hospital from 1978 to 2000. Results Twenty three patients fulfilled the diagnostic criteria (9 male, 14 female, median age 50 years, range 4～75 years).The main symptoms at the presentation were abdominal distension(87%), pain(57%), diarrhea(65%), constipation(48%), vomiting(39%) and weight loss(83%). In this group of CIP patients, the abdominal distension was more common and serious than pain, presenting with diarrhea, weight loss and dismotility in esophagus and stomach. Bowel loops and visible peristaltic waves were seldom observed in the CIP patients. The plain film showed the multiple air-fluid levels (17/20, 85%) and generalized intestinal distention and air in colon. The abnormal findings on the barium contrast examination included intestinal dilation (19/23, 83%), weaken peristalses or/and prolongation of transit time (74%) without mechanical lesions. The pseudo-obstruction involved the small intestine (83%) and colon (39%) that determined according to the radiographic features, abnormal gastrointestinal motor functions, findings of endoscopic examination and laparotomy. Eighteen cases were chronic idiopathic intestinal pseudo-obstruction (1 familial myopathy), 5 were secondary to CTD. Conclusions Comparison with the typical mechanical obstruction, the presentations of CIP have some relatively characteristics. The clinical diagnosis of CIP can be confirmed on the basis of typical clinical symptoms and radiographic features, abnormal gastrointestinal motility.