【摘要】 目的:分析缺血性结肠炎(IC)的临床资料,探讨其早期诊断方法,以提高诊疗水平,减少该病的误诊和漏诊。方法:2011年1月-2017年12月49例确诊为IC的患者,对其年龄、基础疾病、临床表现、实验室检查、内镜下特点、病理学改变及治疗转归等方面进行回顾性分析。结果:共纳入49例IC患者,男女比例1︰2.27,年龄33～87岁,平均年龄62.5岁。其中50岁以上占79.6%(39/49),91.8%(45/49)的患者伴有心脑血管疾病、糖尿病、高脂血症、腹部手术史等基础疾病,以腹痛(95.9%)、腹泻(53.1%)、便血(91.8%)为主要临床表现,体征以左下腹部、脐周或左中腹部压痛(91.8%)。实验室C反应蛋白(CRP)升高(46.9%)、D-二聚体升高(51.0%)。腹部彩超及CT检查提示肠管扩张、肠壁增厚。内镜下病变呈节段性分布,病变部位与正常黏膜分界清楚,病变部位以降结肠(44.9%)、结肠脾曲(49.0%)、乙状结肠(73.5%)为主,表现为黏膜充血、水肿、出血、糜烂及溃疡,本组均为非坏疽型[一过型(87.8%)与狭窄型(12.2%)],病理改变非特异性。确诊后予扩血管、抗凝、抗感染及改善微循环等治疗,2周后42例患者复查肠镜38例(90.5%)痊愈,4例(9.5%)好转,平均住院10.56 d。结论:对有心脑血管等基础疾病的中老年患者,突发左下腹痛及便血时要警惕缺血性结肠炎,早期结肠镜检查、彩色多普勒、腹部CT、CRP、D-二聚体、血脂等检查有助于诊断。IC病情预后与患者年龄、伴随疾病、病变程度及是否早期诊治密切相关。更多还原

【Abstract】 Objective:To analyze the clinical characteristic of ischemic colitis(IC)and investigate methods for its early diagnosis,in order to improve the level of diagnosis and treatment,reduce the misdiagnosis and missed diagnosis of the disease.Method:Clinical data of 49 patients with ischemic colitis were collected from January 2011 and December 2017,age,basic diseases,clinical manifestations,laboratory examination,endoscopic characteristics,pathological changes and treatment reclassification were retrospective analyzed. Result:A total of 49 patients with IC were enrolled in the study,the ratio of males and females was 1︰2.27,and the age was 33-87 years old,with an average age of 62.5 years old.More than 50 years old accounted for 79.6%(39/49),91.8%(45/49)associated with cardiovascular disease,diabetes,hyperlipidemia,abdominal surgery history,such as basic diseases,with abdominal pain(95.9%),diarrhea(53.0%),bloody(91.8%)as the main clinical manifestations,signs in the lower left abdomen,periumbilical or left abdomen tenderness (91.8%).Laboratory C-reactive protein(CRP)increased(46.9%)and D-dimer increased(51.0%).Abdominal ultrasonography and CT examination indicated the expansion of the intestinal tube and thickening of the intestinal wall.Endoscopic lesions with segmental distribution,a clear demarcation between the lesion and normal mucosa,pathological changes in descending colon(44.9%),splenic flexure colon(49.0%),sigmoid colon(73.5%),characterized by mucosal hyperemia,edema,hemorrhage,erosion and ulcer,all of the groups were non-gangrene(type 87.8% and stenosis 12.2%),and pathological changes were nonspecific.After the diagnosis,the patients were treated with dilated blood vessels,anticoagulation,anti-infection and improved microcirculation.After 2 weeks, 42 patients were cured by reexamination of 38 cases(90.5%),4 cases(9.5%) improved,the average length of hospitalization was 10.56 d.Conclusion:For elderly patients with basic diseases such as cardiovascular and cerebrovascular diseases,to be aware of ischemic colitis when acute left abdominal pain and hematopoiesis occur.Early colonoscopy and color doppler,abdominal CT,CRP,D-dimer,and blood lipids are helpful for diagnosis.The prognosis of IC is closely related to the age of the patient,the kinds of diseases,the degree of disease,and the early diagnosis and treatment.更多还原