摘要
目的探讨缺血性结肠炎(Ischemic Colitis,IC)的临床特征,提高医师对该病的早期识别能力,减少误诊,做到早诊早治。方法回顾分析2014年1月1日至2020年1月31日于我院住院确诊IC患者的临床资料了解IC临床特征。结果110例IC患者男女比例约1∶1.62,年龄55~69岁的患者最多,各年龄段中,≥60岁患者所占比例最高。便血(87.3%)、腹痛(87.3%)、腹泻(83.6%)为最常见症状,约70.9%患者上述三联征均出现。体征多为腹部压痛(63.6%)、反跳痛(7.3%)、肠鸣音增强或减弱(10%、7.3%)。其中压痛部位主要位于左下腹(34.3%)。内镜下单一部位受累17.3%,多个部位受累82.7%,降结肠(60%)、乙状结肠(56.4%)、横结肠(37.3%)为最常见受累部位。内镜下主要有黏膜充血水肿、糜烂、红斑、血管纹理不清、溃疡等表现,溃疡形态以纵形、不规则形及环形溃疡多见。病理有黏膜出血斑、玻璃样变、腺体萎缩等改变。CT或腹主动脉CTA多提示管壁增厚、浆膜面或边缘毛糙、管壁周围渗出等肠道病变及动脉硬化、腹主动脉或肠系膜动脉狭窄等血管病变。IC患者可有炎症指标、生化指标等实验室检查异常,肠道溃疡者较未出现肠道溃疡者白细胞计数升高更显著。误诊率约39.1%,结肠癌是最易误诊疾病。保守治疗效果好。结论IC临床及内镜表现多样,影像学及实验室等辅助检查缺乏特异性,全面了解IC患者的临床特征有助于减少误诊,做到早识别、早治疗。
Objective To explore the clinical characteristics of ischemic colitis(IC),improve the early recognition ability,reduce misdiagnosis and treat it early.Methods The clinical data of patients with IC diagnosed in our hospital from January 1,2014 to January 31,2020 were retrospectively analyzed to understand the clinical characteristics in IC.Results The proportion of men and women in 110 IC patients was about 1∶1.62,the most patients aged 55-69 years old,and the proportion of patients aged more than 60 years old was the highest among all ages.The most common symptoms were blood free(87.3%),abdominal pain(87.3%),diarrhea(83.6%),and 70.9%of the patients had the above-mentioned triple syndrome.The signs were abdominal tenderness(63.6%),rebound pain(7.3%),and the enhancement or decrease of the bowel sounds(10%,7.3%).The tenderness was mainly located in the left lower abdomen(34.3%).The most common part was the descending colon(60%),sigmoid colon(56.4%),transverse colon(37.3%).The main manifestations of endoscopic mucosa are hyperemia and edema,erosion,erythema,unclear vascular texture and ulcer.The ulcer forms are mostly longitudinal,irregular and annular ulcers.The pathological changes include bleeding spots,glass like changes and atrophy of glands.CT or CTA of abdominal aorta often indicates the thickening of the wall,rough serous surface or edge,exudation around the wall,and vascular lesions such as arteriosclerosis,abdominal aorta or mesenteric artery stenosis.The abnormal laboratory examination of IC patients can be found,such as inflammation index and biochemical index,and the leukocyte count of patients with intestinal ulcer is higher than that of those without intestinal ulcer.The misdiagnosis rate is about 39.1%,colon cancer is the most easily misdiagnosed disease.The conservative treatment was effective.Conclusion The clinical and endoscopic manifestations of IC are diverse,and the imaging and laboratory assistant examination are lack of specificity.To understand the clinical characteristics of IC patients i
作者
贾若男
王杨
姚乐
刘茜
霍晓霞
尹凤荣
张晓岚
JIA Ruo-nan;WANG Yang;YAO Yue;LIU Qian;HUO Xiao-xia;YIN Feng-rong;ZHANG Xiao-lan(Department of Gastroentology,the Second Hospital of Hebei Medical University,Shijiazhuang050000,China)
出处
《中国误诊学杂志》
CAS
2021年第5期390-394,共5页
Chinese Journal of Misdiagnostics
关键词
结肠炎
缺血性
临床表现
内镜特征
误诊
colitis,ischemic
clinical manifestations
endoscopic features
misdiagnosis
