成人巨结肠10例分析

Analysis of 10 cases of adult megacolon

目的,探讨成人巨结肠的病例特点,减少其误诊率,提高对成人巨结肠的认识。方法,回顾分析2014至2018年于山东省千佛山医院确诊为成人巨结肠10例患者的临床资料,总结起病症状、发病时间、误诊的疾病类型、诊断方法及治疗方式、转归情况。结果,10例成人巨结肠患者中男性(6例)病患多于女性(4例);发病时间1周至5年,于当地医院误诊为肠梗阻、肠道功能紊乱、十二指肠淤积症、顽固性便秘等。10例患者接受手术治疗,行结肠次全或者全结肠切除,回肠直肠吻合。手术后的病理证实为成人先天性巨结肠。行手术治疗的患者半年来院复查肠钡剂灌肠较前明显缓解,且能规律排便,行全结肠切除回肠直肠吻合的患者无再复发。结论,成人巨结肠确诊多依赖于手术活检病理。内科保守治疗效果差,手术切除后患者肠梗阻症状减轻,排便较前规律。

Objective To explore the case characteristics of adult megacolon,reduce its misdiagnosis rate and improve the understanding of adult megacolon. Methods The clinical data of 10 cases with adult megacolon diagnosed in Qianfoshan Hospital of Shandong Province from 2014 to 2018 were retrospectively analyzed.The initial symptoms,attack time,type of disease misdiagnosed,diagnostic method,therapy method and prognosis condition were summarized. Results There were more males(6 cases)than females(4 cases)among the 10 patients with adult megacolon.The time of onset ranged from 1 week to 5 years,and it was very easy for local hospitals to be misdiagnosed as intestinal obstruction,intestinal dysfunction,duodenal stasis and intractable constipation,etc.All the patients were treated with operation,such as subtotal colectomy or total colectomy and ileorectal anastomosis,and were confirmed by postoperative pathology.The reexamination of barium enema after half a year showed that the results were obviously improved,and all the patients had regular bowel movements.There was no recurrence among the patients who received total colectomy and ileorectal anastomosis. Conclusion The diagnosis of adult megacolon depends mostly on surgical biopsy pathology.The effect of internal medicine conservative treatment is poor.The symptoms of intestinal obstruction are alleviated after surgical resection,and defecation is more regular than before.