肠气囊肿症12例的诊治分析

A report of 12 cases of pneumatosis cystoides intestinalis

目的探讨肠气囊肿症（PCI）的发病特点和恰当的诊治方式。方法对1997年至2015年在天津医科大学总医院确诊的12例PCI患者进行分析，评估其病因、内镜特点、治疗效果及预后。结果4例因长期接触三氯乙烯或病因不明导致原发性PCI；其余8例为继发性PCI，患有白塞病、结缔组织病、肺气肿、糖尿病、恶性肿瘤等。内镜表现包括单发泡状气囊肿、线状或鹅卵石样气囊肿、葡萄或串珠状气囊肿等，病变累及乙状结肠6例、升结肠3例、降结肠2例、十二指肠2例、直肠1例。药物或联合内镜治疗后，8例明显缓解，2例好转，2例因恶性肿瘤死亡。结论PCI是一种罕见病证，病因机制尚不明确，多继发于其他疾病，通过结肠镜、超声内镜可明确诊断。单发性PCI可行内镜下高频电切除治疗，多发性PCI予内镜下囊肿夹破、抗生素联合菌群调节药物治疗效果显著。积极治疗原发病，早期发现并发症可改善预后并减少复发。

Objective To investigate the characteristics and treatment for pneumatosis cystoides intestinalis （PCI）. Methods Data of 12 PCI patients admitted to General Hospital of Tianjin Medical University from 1997 to 2015 were analyzed. The causes, endoscopic characteristics, therapeutic effects and prognosis were evaluated. Results Four cases were primary PCI due to long-term exposure to trichloroethylene or unknown reasons, while 8 other cases were secondary to Behcet＇s disease, connective tissue disease, emphysema, diabetes, therioma, etc. Endoscopic findings included bubble-like, linear, cobblestone-like, graped or beaded gas cysts, involving sigmoid in 6 cases, ascending colon in 3, descending colon in 2, duodenum in 2 and rectum in 1. After combination of medicinal and endoscopic treatment, symptoms of 8 patients were relieved, and the condition of 2 patients improved, while 2 patients died of malignancy. Conclusion Pneumatosis intestinalis is a rare disease, usually secondary to other diseases, which can be diagnosed by colonoscopy and ultrasonic endoscopy. Pathogenesis of PCI is still unclear. Single PCI can be cured with endoscopic resection. Multiple PCI can be managed with cyst clipping, antibiotics and intestinal flora regulator. Treatment of the original disease and early detection of complications can improve the prognosis and reduce recurrence of PCI.