缺血性结肠炎诊治现状

Current status of diagnosis and treatment of ischemic colitis

缺血性结肠炎(ischemic colitis,IC)是缺血性肠病中最常见的类型,也是下消化道出血的常见原因之一,由于肠道血流不能满足代谢需要导致大肠的特定肠段非感染性的炎症。IC病因多样,小血管病变、休克导致的全身血流灌注不足、缩血管药物的使用、腹部血管手术、便秘等可导致IC。老年人高发,临床表现无特异性,多数患者表现为急性的痉挛性腹痛、腹泻、排便急迫感和便血。结肠镜及活检病理检查在早期诊断中具有重要地位。大多数患者为一过性的非坏疽型的缺血,经内科保守治疗即可痊愈。但部分患者重度缺血出现结肠全层坏死、穿孔甚至多脏器功能衰竭。

Ischemic colitis （IC） is the most prevalent form of gastrointestinal ischemia and a noninfectious inflammation of the bowel caused by intestinal blood flow that is inadequate to serve the metabolic demands of the colon in a specific region.The etiology of IC is multifactorial.Small-vessel diseases,systemic hypoperfusion due to all kinds of situations involving shock,drugs with effect of vasoconstrictive,abdominal vascular surgery,and constipation can cause IC.IC mainly affects elderly patients.Clinical manifestation of IC is non-specific.Most patients present with a sudden onset of crampy abdominal pain,diarrhea and an urge to defecate.Since IC symptoms are not typical,it requires early colonoscopy to clarify diagnosis.Most patients have transient,nongangrenous ischemia,but some have severe ischemia,which may progress to transmural necrosis,perforation,multi-organ failure.