缺血性结肠炎临床特点和内镜特征及转归分析

Clinical Features,Endoscopic Characteristics and Outcome of Patients With Ischemic Colitis

目的探讨缺血性结肠炎(IC)患者的临床特点、内镜特征及转归。方法选取2008年1月—2014年6月昆明医科大学附属延安医院消化内科收治的81例IC患者的临床资料,回顾性分析其临床表现、基础疾病、实验室检查、结肠镜检查、腹部CT检查结果及转归。结果 IC多发于中老年患者,多数合并有高脂血症、高血压、糖尿病或糖耐量异常以及动脉粥样硬化等基础疾病。主要临床表现为下腹痛,餐后加重,腹泻及便血。非坏疽型IC患者80例和坏疽型IC患者1例。非坏疽型IC结肠镜下常以黏膜充血、水肿、糜烂、纵型溃疡形成等改变为主要表现,病变严重者出现肠壁增厚、结肠袋消失及肠腔狭窄;坏疽型IC结肠镜下表现为黏膜广泛发紫及假性息肉形成,病变部位位于左半结肠,呈节段性分布,患者预后良好。疾病转归与病变部位、程度、有无并发症、伴随基础疾病情况有关。结论 IC的临床及结肠镜表现无明显特异性。临床上对于出现急性下腹痛及便血,既往有高脂血症、高血压、糖尿病以及动脉粥样硬化等疾病基础的患者应警惕IC可能,及早进行结肠镜检查,可明确诊断,有助于判断预后。治疗后第2次结肠镜检查对IC的诊断有着重要意义。

Objective To investigate the clinical features,endoscopic characteristics and outcome of patients with ischemic colitis（ IC）. Methods Collected the clinical data of 81 patients with ischemic colitis who were admitted into the Department of Gastroenterology of the Affiliated Yanan Hospital of Kunming Medical University from January 2008 to June2014. Retrospective analyses were conducted on clinical manifestation, underlying diseases, laboratory examination,colonoscopy,abdomen CT scan and outcome. Results Ischemic colitis mostly occurred in elderly patients,most of whom were complicated with hyperlipemia,hypertension,diabetes and atherosclerosis. The clinical predominant symptoms were abdominal pain,aggravation after meals, diarrhea and hematochezia. There were 80 non- gangrene patients and only one gangrene patient. For non- gangrene patients, major manifestations under colonoscopy included mucosal hyperemia, edema, erosion,longitudinal ulceration,and serious non- gangrene patients had bowel wall thickening,the disappearing of haustrum and bowel stenosis; for gangrene patients,major manifestations under colonoscopy included expansive blue in mucosa and pseudo polyps,and the lesions mostly occurred in left hemicolon and took on segmental distribution. Most patients had favorable outcomes. The outcome was associated with lesion position, lesion degree, having complications or not and underlying diseases,etc. Conclusion The clinical features and endoscopic characteristics of IC patients have no obvious specificity. When abdominal pain and bloody stools occur in elderly patients with diseases such as hyperlipemia,diabetes,hypertension and atherosclerosis,ischemic colitis should be cautioned. Colonoscopy at an early stage is important for definite diagnosis and estimating prognosis. Second colonoscopy examination has great significance on the diagnosis of IC.