电子肠镜诊治结肠憩室924例分析

Analysis of 924 cases of colonic diverticulum diagnosed and treated by electronic enterocopy

目的研究福建漳州地区人群结肠憩室的患病情况,探讨电子肠镜在结肠憩室诊治中的应用价值。方法回顾性分析2012年1月至2017年12月在我院行电子肠镜检查并明确诊断为结肠憩室患者的病例资料。结果共纳入患者924例,男603例,女321例,男性明显多于女性(P<0.0001)。83.7%患者主诉有腹痛、腹胀、排便习惯改变和血便/黑便症状。憩室部位以右半结肠多见(87.6%),单发与多发憩室差异有统计学意义(P<0.0001)。86例(9.3%)患者有憩室相关并发症,>60岁组并发症发生率较高,严重并发症多见。86例中,48例仅粪石嵌顿,20例粪石嵌顿伴憩室炎,15例憩室炎并出血,2例粪石嵌顿伴出血,1例憩室炎伴慢性溃疡并穿孔。47例粪石嵌顿的患者,门诊行肠镜检查时,使用活检钳钳除联合内镜下冲洗解除嵌顿。其余39例患者收入消化内科经内镜联合内科保守治疗,其中1例患者因再出血转外科手术,其余患者疗效确切。结论本地区憩室检出率呈逐年上升趋势,患者年龄趋于年轻化,男性患者明显多于女性患者,憩室部位以右半结肠多见,并发症的发生率和严重程度与年龄呈正相关。对于>60岁结肠憩室患者,应给予更加密切的随访,以及可以综合憩室大小等因素,酌情给予内镜下套扎等预防出血和穿孔的干预措施以避免严重并发症的发生。

Objective To study the prevalence of colonic diverticulum in Zhangzhou area of Fujian,and to explore the application value of electronic colonoscopy in the diagnosis and treatment of colonic diverticulum.[WTHZ]Methods The data of patients with colonic diverticulum diagnosed by electronic colonoscopy in our hospital from Jan.2012 to Dec.2017 were selected and retrospectively analyzed.[WTHZ]Results There were 924 patients selected,including 603 males and 321 females.The number of males was significantly more than that of females(P<0.0001).There were 83.7%of the patients complained of abdominal pain,abdominal distension,changes in defecation habits and bloody/black stool symptoms.Diverticulum was mainly located in the right colon(87.6%).There was significant difference between single diverticulum and multiple diverticulum(P<0.0001).Eighty-six patients(9.3%)had diverticulum related complications.The incidence of complications was higher in patients over 60 years old,and severe complications were more common.Among 86 cases,48 cases were only incarcerated with fecal calculus,20 cases with diverticulitis,15 cases with diverticulitis and hemorrhage,2 cases with fecal calculus incarcerated with hemorrhage,1 case with diverticulum with chronic ulcer and perforation.In 47 patients with fecal calculus incarceration,biopsy forceps combined with endoscopic irrigation were used to remove the incarceration.The remaining 39 patients were admitted to the Department of Gastroenterology,and were treated by endoscopy combined with conservative medicine.One patient was transferred to surgery due to rebleeding,and the other patients had definite curative effect.[WTHZ]Conclusion The detection rate of diverticulum in this area is increasing year by year,the age of patients tends to be younger,male patients are significantly more than female patients,diverticulum site is more common in the right colon,the incidence and severity of complications are positively correlated with age.For patients over 60 years old with colonic diverticulum,more close follow-up should be given,combined with diverticulum size and other factors.Endoscopic ligation and other interventions to prevent bleeding and perforation should be given to avoid the occurrence of serious complications.