急性缺血性肠炎临床诊治及误诊原因分析

The clinical diagnosis and treatment of acute ischemic colitis and misdiagnosis reason analysis

目的研究急性缺血性肠炎的临床特点及诊治情况,并分析误诊原因,以提高对急性缺血性肠炎疾病的认识,减少误诊率。方法回顾性分析杭州市第三人民医院肛肠外科2007—2013年收治的急性缺血性肠炎患者26例,查阅病历并对患者的年龄、性别、临床表现、结肠镜下表现、病理组织学特点、治疗情况、误诊原因等相关资料进行对比分析。结果 26例患者均出现腹痛(100.0%),其中左侧腹痛16例(61.5%);20例患者出现便血(76.9%),其中鲜血便12例,黏液脓血便8例;11例出现恶心呕吐(42.3%)、9例出现发热(34.6%)、2例出现里急后重(3.8%)。所有患者均经过积极的治疗,25例患者的症状全部缓解,1个月后复查结肠镜,其中21例病变肠段完全恢复正常,2例仍遗留充血、血管纹理紊乱,1例见假性息肉形成,1例留有肠腔狭窄。另有1例患者进行外科手术切除部分肠管,已痊愈。其中初诊为急性细菌性痢疾5例,急性胃肠炎4例,不全性肠梗阻6例,溃疡性结肠炎3例,初诊误诊率达69.2%(18/26)。结论急性缺血性肠炎早期临床表现缺乏特异性,肠镜表现不典型,诊断较为困难,很容易误诊,临床医生要警惕此病。

Objective To study clinical characteristics,diagnosis and treatment of acute ischemic colitis,and analyze the causes of misdiagnosis,to raise awareness of acute ischemic enteritis disease,and reduce the rate of misdiagnosis. Methods A retrospective analysis of 26 cases of patients with acute ischemic colitis in Third People＇s Hospital of Hangzhou anorectal surgery in 2007—2013 wan conducted. Medical records and the patient＇s age,sex,clinical manifestations,colon endoscopic findings,histopathological features,treatment,misdiagnosis and other related information were analyzed. Results 26 cases of patients were abdominal pain（ 100%）,of which the left abdominal pain in 16 patients（ 61. 5%）; 20 cases of patients with bloody diarrhea（ 76. 9%）,12 cases in which blood will mucus pus 8 cases; 11 cases of nausea and vomiting（ 42. 3%）,9 cases of fever（ 34. 6%）,two cases appear tenesmus（ 3. 8%）. All patients had to undergo aggressive treatment,the patient＇s symptoms remission of all 25 cases,a month later colonoscopy,including 21 cases of bowel disease was completely back to normal,two cases still left hyperemia,vascular texture disorder,one case with pseudo polyps formation,one case left luminal stenosis. Another one patient received surgical removal of part of the intestine,and was recovered. Of which five cases were diagnosed as acute bacillary dysentery,acute gastroenteritis in four cases,six cases of incomplete intestinal obstruction,ulcerative colitis in three cases,misdiagnosis rate was 69. 2%（ 18 /26）. Conclusion Early clinical manifestations of acute ischemic colitis was lack of specificity,colonoscopy was not typical,the diagnosis was difficult,it can be easily misdiagnosed,clinicians should be alert to the disease.