缺血性结肠炎70例临床特点分析

Clinical Characteristics of Ischemic Colitis: A Report of 70 Cases

目的分析缺血性结肠炎(ischemic colitis,IC)的临床特点,提高对该病的认识及临床诊治水平。方法回顾性分析2015年2月-2018年8月的70例诊断明确的IC患者的临床症状、内镜表现、实验室检查及诊治结果等特点。结果 IC多发生于中老年人,女性多于男性,除最常合并高血压外,还合并糖代谢异常、心脑血管疾病、以及慢性肺疾病等。主要症状为腹痛、血便、腹泻等,可伴随恶心、呕吐、发热。60.0%患者出现D-二聚体升高,病变多位于左半结肠,内镜表现为节段性的充血水肿、糜烂、溃疡。经内科治疗大多数好转,少数坏疽型需外科干预。结论具有相关基础疾病的中老年人,短期内出现腹痛、便血为主要表现者,应查D二聚体,并尽早行肠镜检查明确有无IC。

Objective To analyze the clinical characteristics of ischemic colitis(IC), and to improve the understanding and diagnosis of ischemic colitis. Methods The clinical symptoms, endoscopic manifestations,laboratory testing, diagnosis and treatment results of 70 patients with IC from February 2015 to August 2018 were analyzed retrospectively.Results IC mostly occurred in the elderly with more females than males. These patients often had concomitant basic diseases, such as hypertension, abnormal glucose metabolism, cardiovascular and cerebrovascular diseases, and chronic lung diseases. The main symptoms are abdominal pain, bloody stools and diarrhea, which may be accompanied by nausea, vomiting and fever. Elevated D-dimer was found in 60.0% of the patients. Most of the lesions were located in left colon. The endoscopic manifestations were segmenting hyperemia,edema, erosion and ulcer. Most of them relieved after conservative medical treatment, but a few cases of gangrene type required surgical intervention. Conclusion For the middle-aged and elderly patients with concomitant basic diseases, acute abdominal pain and bloody stool as the main manifestations, early colonoscopy in combination with D-dimer testing should be performed for accurate diagnosis.