东西方结肠憩室发病原因及影响因素

消化道憩室指局部消化系病理性疝于肠壁的囊袋状突出.近年来,通过尸检报告发现憩室病发病率不断增高.在发病机制上,结肠憩室的发生与结肠本身的解剖特点、肠道运动神经功能紊乱、肠内细菌过度繁殖、激素水平紊乱等诸多因素相关.与此同时,结肠憩室还受种族、性别、地区环境、食物摄入、运动情况等因素影响.以往研究结显示,结肠憩室在东西方不同地区的流行病学特点存在明显的差异,且目前造成这一差异的原因尚未明确,其中西方国家人群的高脂、低纤维饮食习惯可能是重要的诱发因素.本文从结肠憩室的发病原因、发病机制以及影响因素等方面对东西方结肠憩室的差异及特点进行了综述.

Pattern and distribution of colonic diverticulosis:Analysis of 2877 barium enemas in Thailand

AIM:To determine the pattern and distribution of colonic diverticulosis in Thai adults.METHODS:A review of the computerized radiology database for double contrast barium enema(DCBE)in Thai adults was performed at the Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.Incomplete studies and DCBE examinations performed in non-Thai individuals were excluded.The pattern and distribution of colonic diverticulosis detected during DCBE studies from June 2009 to October 2011 were determined.The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were reported.Factors influencing the presence of colonic diverticulosis were evaluated.RESULTS:A total of 2877 suitable DCBE examinations were retrospectively reviewed.The mean age of patients was 59.8±14.7 years.Of these patients,1778(61.8%)were female and 700(24.3%)were asymptomatic.Colonic diverticulosis was identified in 820patients(28.5%).Right-sided diverticulosis(641 cases;22.3%)was more frequently reported than left-sided diverticulosis(383 cases;13.3%).Pancolonic diverticulosis was found in 98 cases(3.4%).The occurrence of solitary cecal diverticulum,rectal diverticulum and giant diverticulum were 1.5%(42 cases),0.4%(12 cases),and 0.03%(1 case),respectively.There was no significant difference in the overall occurrence of colonic diverticulosis between male and female patients(28.3%vs 28.6%,P=0.85).DCBE examinations performed in patients with some gastrointestinal symptoms revealed the frequent occurrence of colonic diverticulosis compared with those performed in asymptomatic individuals(29.5%vs 25.3%,P=0.03).Change in bowel habit was strongly associated with the presence of diverticulosis(a relative risk of 1.39;P=0.005).The presence of diverticulosis was not correlated with age in symptomatic patients or asymptomatic individuals(P>0.05).CONCLUSION:Colonic diverticulosis was identified in28.5%of DCBE examinations in Thai adults.There was no association between the presence of diverticulosis and gender or age.

西沙群岛星虫类研究Ⅲ——石管星虫属Lithacrosiphon

本文连续报道南海西沙群岛星虫类的第三部分即石管星虫属(Lithacrosiphon)。本属系1902年由Shipley氏订立。据文献记载属中的种均分布于热带海,通常钻孔于珊瑚石中。作者仅鉴定了马岛石管星虫(Lithac-rosiphon maldivensis Shipley)一种。本属在中国海是首次记载。

犬特大型直肠憩室的诊治

老年犬直肠憩室疾病的特征为排便不畅,容易与其他直肠末端疾病相混淆,如犬会阴疝疾病,犬直肠肿瘤疾病,犬肛周疾病等。试验病例犬直肠憩室很大、憩室内容物很多,借助口服肠道造影剂,经肛门注射造影剂后拍摄X光片,得到正确诊断,患犬成功痊愈。目前,手术切除直肠憩室是对本疾病唯一有效的治疗方案,手术后需要精心饲喂,细心护理。

直肠憩室穿孔致腹膜外积气的诊断和治疗

直肠憩室是临床一种罕见疾病。因其易形成脓肿发生穿孔或破裂，表现为急性弥漫性腹膜炎的症状和体征，常与阑尾炎、直肠肿瘤、肠梗阻等其他腹部疾病相混淆，诊断上存在一定困难。本文回顾性分析第三军医大学大坪医院收治的1例直肠憩室穿孔致腹膜外积气患者的临床资料，旨在探讨该类疾病的诊断及鉴别诊断、治疗方法及技巧。