摘要
背景与目的:缺血性结肠炎(IC)是缺血性肠病中常见的一种类型,也是临床诊断较为困难的一种疾病,早期误诊率高,部分患者发病后病情急剧恶化,病死率较高。本文总结分析IC的临床特点,以期为该病的临床诊治提供参考。方法:回顾2010年1月—2019年9月中南大学附属湘雅医院收治的101例IC患者的临床资料。分析患者的一般资料、临床表现、内镜下特点和疾病转归情况,并比较不同年龄组患者临床特征的差异。结果:101例均为初发IC患者,其中女性62例(61.4%);年龄为45~93岁,平均年龄为(63±8.8)岁。包括45~<60岁39例(中年组),≥60岁62例(老年组)。患者主要症状为便血、下腹痛、恶心、腹胀;结肠镜下主要表现为黏膜充血、水肿、血管纹理紊乱、糜烂和溃疡;左半结肠受累69例(68.3%)、右半结肠受累7例(6.9%)、广泛结肠受累25例(24.8%)。81例(80.2%)行腹腔血管检查,其中提示不同程度的血管狭窄者或血栓形成25例(30.9%),仅动脉硬化者14例(17.3%),无明显异常者42例(51.8%)。大多数行内科保守治疗,症状缓解时间为1~35 d,平均(9.5±4.3)d。老年组与中年组患者性别构成比、结肠受累部位、主要症状缓解时间、总治愈率差异无统计学意义(均P>0.05);老年组患有高血压、冠心病及脑部血管疾病史比例明显多于中年组,腹腔动脉狭窄、腹腔动脉硬化比例高于中年组(均P<0.05)。结论:IC好发于老年人,且女性易发病,主要症状为下腹痛及血便,好发于左半结肠。及时进行结肠镜检查有利于IC的确诊。目前IC的主要治疗手段以内科保守治疗为主,老年IC患者合并基础疾病多,腹腔血管条件差,临床工作中应注意正确诊断、早诊早治,改善预后。
Background and Aims:Ischemic colitis (IC) is a common type of ischemic bowel disease,and is also a condition with difficult clinical diagnosis.The early misdiagnosis rate is high,and some patients will rapidly deteriorate after onset,with high associated mortality.This study was conducted to summarize and analyze the clinical characteristics of IC,so as to provide a reference for the its diagnosis and treatment in clinical practice.Methods:The clinical data of 101 IC patients treated in Xiangya Hospital of Central South University from January 2010 to September 2019 were reviewed.The general features,clinical manifestations,endoscopic findings and outcomes of the patients were analyzed,and the clinical characteristics between different age groups of patients were also compared.Results:All patients had the first onset of IC,of whom,62 cases (61.4%) were females;age ranges from 45 to 93 years old,with an average age of (63±8.8) years,and with age of 45 to <60 years in 39 cases (middle-age group) and ≥60 years in 62 cases (old-age group).The main symptoms of the patients were hematochezia,lower abdominal pain,nausea and abdominal distension.The main colonoscopic findings were mucosal erythema,edema,vascular pattern abnormalities,erosion and ulceration.Left colon involvement was found in 69 cases (68.3%),right colon involvement was found in 7 cases (6.9%),and extensive colon involvement was in 25 cases (24.8%),respectively.Eighty-one patients (80.2%) underwent abdominal vascular examination,of whom,vascular stenosis or thrombosis formation was detected in 25 cases (30.9%),simple arteriosclerosis was noted in 14 cases (17.3%) and 42 cases (51.8%) showed no obvious abnormity.Most of the patients received conservative medical treatment only,the time for symptom relief was 1 to 35 d,with an average time of (9.5±4.3) d.There were no significant differences in sex composition,location of colon involvement,time for main symptom relief,and total cure rates between old-age group and middle-age group (all P>0.05);the proportions of cases with history of hypertension,coronary heart disease and cerebral vascular disease were higher,and the proportions of cases with stenosis and arteriosclerosis of celiac arteries in old-aged group were higher than those in middle-age group (all P<0.05).Conclusion:IC occurs frequently in elderly individuals,with a high prevalence in women.The main symptoms are lower abdominal pain and blood in stool,and the left colon is the most affected location.Timely colonoscopy is helpful for making definite diagnosis of IC.Currently,the main treatment modality for IC is conservative treatment based on internal medicine.Elderly IC patients always have underlying health conditions,with poor abdominal vascular conditions,for whom,correct diagnosis as well as early diagnosis and treatment are important for improving the prognosis.
作者
龙禛朴
余阳华
陈霄霄
黄昊苏
彭杰
LONG Zhenpu;YU Yanghua;CHEN Xiaoxioa;HUANG Haosu;PENG Jie(Department of Gastroenterology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第8期979-986,共8页
China Journal of General Surgery
基金
湖南省自然科学基金资助项目(2019JJ40524)
湖南省卫计委科研基金资助项目(20180730)。
