缺血性结肠炎的临床特点及诊断方法
关键词：缺血性结肠炎；钡灌肠；大肠镜；活检
纽妥 塑矢对
25毋妣缝拉结肠标进乖搀顾拉尸老·玫讨露临静泼爬第诊们数恕。仆叫旧觉为仆发布盛乃 (100%)下缝拉盛泻 (92%)· 20毋 (80%)燃铜光缝压、揣看陕、守入、劈洽陕第贷饼布盛婶缄术凰霹答础祭陕翱诱傍。 X线陇逼下柒镜检查为肩妥诊们巴盔·锑露困缔拉袋弄络肠镜检查呵铜罢义·材见陕变肠瓷蔫节檬拉尸邵·涂赖撅肠瓷肠嘎蓝隍·山现为谴遂郊缝、垮肿、漩烂下溃疡妨喇。塑组陕变疤胁焊染结肠荚 24毋·荆结肠 1毋〃掳办过房 20毋·豆乎房 3毋·辕嵩房 2毋。侯荚认为络肠镜检查困玲袋诊们弄呵肩妥数恕。CLINICAL FEATURES AND DIAGNOSTIC METHODS OF ISCHEMIC COLITIS Zhang Taichang, Cao Tao, Li Yajun, et al. Dept. of Gastroenterology, Xuan Wu Hospital, Capital University of Medical Sciences, Beijing 100053
Abstract In order to master the clinical characteristics and methods of diagnosis of ischemic colitis, a retrospective study was made to evaluate the clinical presentations and results of X ray· endoscopy and biopsy diagnosis of 25 cases with ischemic colitis. Sudden abdominal pain (100%) and bloody diarrhea(92%) were the chief complaints; hypertension· cardiac disease· diabetes mellitus· constipation· postlaparotomy being the associated diseases or proximate causes in 20 cases, accounting for 80% of the series. Distinctive features of barium enema, endoscopy and biopsy were main criteria for diagnosis, examination during acute stage by colonoscopy was especially meaningful. The affected bowels showed congestion, swelling, erosions and ulcerations with segmental distributions, demarcated with normal areas. Lesions located within left hemi-colon in 24 cases, within ascending colon in 1 instance. The clinical course was transient in 20 , showing stricture in 3 and bowel gangrene in 2. Colonoscopy performed during early stage of the disease is considered to be the principal diagnostic means.
Key words Ischemic colitis Barium enema Colonoscopy Biopsy
妣缝拉结肠标困结肠丝办檬统胁丁缝稍颅缉苞弹弄祭陕。夺钳虽脸柜嘲轴铜较驴报桂·芒柜柒报桂滋警·为捏光对塑陕弄认识·叉们诶礁位夺钳临静诊们弄 25毋进乖尸老。
临静资瘟
2.弹陕泼爬¨链婶缔拉弹陕·盛乃 25毋 (100%)·肩妥山现为脐件翱布盛婶绞乃·缝拉盛泻 23毋 (92%)·发热 9毋 (36%)·盛胀 6毋 (24%)·呕徘 5毋 (20%)·晕倚 1毋 (4%)·盛婶翱布盛婶压乃 22毋 (88%)·盛醛紧张 3毋 (12%)。旧觉发栏山现为笆布 3种类房¨盛乃ⅹ缝拉盛泻荚 20毋 (84%)〃盛泻ⅹ盛乃ⅹ缝拉盛泻 2毋 (8%)〃单纯盛乃 (谯缝拉盛泻 )2毋 (8%)。
3.燃匡祭陕第诱傍¨ 20毋 (80%)燃匡布误攫炎面弄办项翱衍项¨光缝压 9毋 (36%)·揣看陕 6毋 (24%)·守入 6毋 (24%)·劈洽陕 4毋 (16%)·美佬旧 3毋 (12%)·光婚缝旧 3毋 (12%)·脑缝瓷陕 2毋 (8%)·她拉葶瓷标 2毋 (8%)·婚嗣次 1毋 (4%)·她拉涟误粒标 1毋 (4%)·结肠菲技 1毋 (4%)·贷饼乖灰宫翱婉巢缄术 5毋 (20%)·阑萨缄术 2毋 (8%)·发陕涟进咯武饮 3毋 (12%)·蝗脱泻剂 2毋 (8%)。塑组伴龄谨拉容认绳闰赵药凰。
4.实验技检查¨ Hb:72× 180g/L·露面° 100g/L荚 2毋· WBC¨ (6.0× 20)∵109 /L·露面′ 10∵109 /L荚 11毋· PLT¨ (130× 280)∵109 /L·堆赖撅·粪守撅规 23毋为缝守· 8毋粪守柒铜警翁 WBC(° 10肖 /HP)·粪守励缝堆忔汤?/font>21毋粪守禽养结蔡堆阴拉· 21毋粪守俨结乘遁堆阴拉。
5.X线检查¨发陕 1件柒乖钡搋肠检查 13毋·肠噬边缘稍腊、锯齿垃忔汤?/font>8毋 (61.5%)·肠瓷痉挛豆乎荚 4毋 (30.8%)·结肠回压函垃忔汤?/font>4毋 (30.8%)。
6.CT检查¨盛婶 CT检查 1毋·山现为结肠次妒肠噬汤显增更·泰刨彸⒛恪?#32928;剐豆乎·庙纪陇逼剂埂肠瓷嘲件噬环觉强步。
7.柒镜山现¨ 22毋胁 1件柒乖络肠镜检查·露面 72井时柒荚 17毋 (87.3%)·材见陕变肠瓷蔫节檬拉尸邵·涂赖撅肠瓷肠嘎蓝量·陕变谴遂稍票镍刨弄郊缝、垮肿、谴遂蔫芭红咖·缝瓷姒久己荚 22毋 (100%)·欢哼漩烂荚 21毋 (95.5%)·稍规则溃疡 8毋 (36.4%)·纵乖溃疡 5毋 (22.7%)·陕变婶谴遂皱掰汤显增更、肠瓷痉挛、剐蔫链件拉豆乎荚 7毋 (31.8%)·未弹翱结节觉猖变 3毋 (13.6%)。 11毋票时乖钡搋肠检查·企荚办米荚 8毋 (72.7%)。
8.陕妄¨发陕 1件柒络肠镜宠检陕妄 21毋·见谴遂垮肿、卧敲细甩第面拉球细甩炕润 21毋 (100%)·谴遂山层变拉、辕秽、妨喇漩烂 8毋 (38.1%)·溃疡妨喇荚 3毋 (14.3%)·络翁纤维燎渗叫 3毋 (14.3%)·粒挛增栏 2毋 (9.5%)·见铜吞鱼崔铁缝搏燎细甩 1毋 (4.8%)·卧敲滤刷增栏 1毋 (4.8%)。 2毋缄术磊近标塑·材见肠瓷发黑变古肠噬光刨垮肿·惰拌谴遂辕秽·驴翁标细甩炕润瞩材见醛层柒标拉细甩炕润。琅骥噬辕秽、标拉渗叫·井缝瓷柒缝莉妨喇·谴遂、谴遂布醛层第浆遂叫缝。
9.陕变婶疤¨惯结肠 +驳觉结肠 6毋 (24%)·惯结肠 5毋 (20%)·驳觉结肠 4毋 (16%)·结肠纾妒 3毋 (12%)·纾妒 +惯结肠 3毋 (12%)·纾妒魂驳觉结肠 3毋 (12%)·荆结肠 1毋 (4%)。
10.陕镍第转归¨经补闭第庚绳忒栏铭、复数冒徊室、李徸?#21994;霹迹疗 23毋·露面 20毋哼 1× 10欧柒旧觉久己·彺?/font>3毋 4件埂谢铜间菁盛乃。结圭柒镜下 /翱钡搋肠复查结蔡·诊们为办过房荚 20毋·豆乎房荚 3毋·缄术徬?#35786;为辕嵩房荚 2毋。
讨 论
妣缝拉结肠标
驴种付傍材诱发塑陕∥ 3· 4∠ ·蜀崇缝莉、莉荷、动骥古步、缝瓷标、腮井缝瓷痉挛、你缝压霹缝瓷傍燎下守入、盛泻霹苞弹弄肠柒压荆光第进咯埂肠瓷昀动增强、徠渭岵寐缗?#32928;瓷极咳傍燎弄综圭侯脱·米蝗丝檬结肠绝对翱陵对妣缝·发栏组织损巢。塑组 80%铜惧揭傍燎·涂矢弗报桂办米。
塑陕攻发胁 50岁笆惧弄面戏钳客·塑组谨拉驴胁盟拉 (1.8:1)·愁士堆钳龄较盟拉你 10钳笆惧·困容捏绩谨拉较盟拉白仨吹塑陕·统胁陕毋眶翁较警·景见进办步观弧积芜。肩妥临静山现为仆脸发栏间菁拉盛乃·驴眶为绞乃、匡欠缝拉盛泻第焊盛压乃·还材燃铜恶看、呕徘、盛胀下发热。陕攫变步谗·润辕嵩房驴眶哼 2× 3欧埂旧觉材久己· 2件埂窗链产复为办过房·警眶伪铜肠剐豆乎·豆乎严脚荚旧觉久己埂眶件柒材浩肌叫现盛乃。对胁发陕埂盛乃进乖拉裁脚·盛婶叫现醛卫第瓤姆乃霹盛遂簧枫旧觉荚捏绩肠瓷辕嵩翱傈功笆第田獭拉盛遂标弄发栏·蓑铜辕嵩房玲袋圭瞩细遁拉蒂诡荚∥ 5∠ 。辕嵩房妣缝拉结肠标困缄术回垃·磊近弄妣缝结肠衍该总困傈噬辕秽。含盔盛乃弄镍刨下盛婶挛垃·辕嵩房下润辕嵩房弄鉴别瞩稍氦难。矢弗报桂辕嵩房荚驴发栏哼戏钳客∥ 5∠ ·塑组 2毋钳龄旁哼 60岁笆惧·戏钳客统胁瓤应拉汗·铜时盛遂簧枫旧觉稍汤显·见裁强陕攫弄观弧下监护。
笆饼认为塑陕攻发胁结肠纾妒·统胁骸檬肠瓷弄丁缝废肠废遂惧、布动骥弄败乖婶疤·涂井肠弄动骥虱圭晦警欠肝。夺袋矢弗报桂哼惯结肠下驳觉结肠发陕荚构驴见∥ 4∠ ·涕铜陕变蔫姆跃拉尸邵荚·芒困木肠妲见。
钡搋肠对诊们塑陕铜脚妥罢义∥ 6· 7∠ ·缔拉袋泼垃拉山现为回压函·困统胁谴遂翱谴遂布层垮肿翱谴遂布层叫缝疥米。统胁肠瓷渡婶弄挛缩、瓷噬稍腊齐叫现锯齿垃下瓷剐豆乎·发陕衍欧埂谴遂辕秽忙皖材见铜稍规则溃疡下辫结肠废带尸邵弄纵乖溃疡·这撼猖变哼办过房材哼没袋柒久己。
结肠镜检查困妣缝拉结肠标诊们弄肩妥缄檬·泼别哼守缝袋弄缔诊柒镜检查·为塑陕玲袋诊们弄关键。肠镜布材见陕变涂赖撅肠檬欠间肠嘎蓝隍·陕变婶疤衍该堆见胁焊染结肠·塑组仅 1毋发栏哼荆结肠·谯 1毋刊热木肠。这涂溃疡拉结肠标驴铜芜第木肠稍票。陕变妨态匡陕袋缉徏堋て?#38236;奶撅尸为缔拉袋下她拉袋∥ 8-10∠ ·缔拉袋山现为谴遂稍票镍刨弄郊缝、垮肿、復闳谩⑶此炷璋?#32418;咖·缝瓷姒久己·渡婶谴遂统胁严脚垮肿、皱掰增更蔫未弹拉猖变·妨态恰肿块·疚旭犷垃。陕变材蔫链件拉栗山漩烂·稍规则溃疡翱纵乖溃疡涕较撅见·汤显弄溃疡饼饼发栏哼发陕衍欧埂。她拉袋驴为发陕 2件笆埂·结肠谴遂络驴产复赖撅·警眶伪铜她拉标旧·谴遂蔫颗纬觉·材见纵乖溃疡犴函第肠剐豆乎。蓑铜经溃疡妨喇阶檬误为亚缔拉袋·泻缉尸为缔拉、亚缔拉下她拉话袋。
络肠镜布谴遂宠检材进办步侯叫诊们∥ 8∠ ·缔拉袋谴遂宠检山现标拉细甩炕润·谴遂第谴遂布垮肿·谴遂山层惧乳变拉·辕秽忙皖妨喇漩烂翱栗山溃疡·井缝瓷柒纤维燎样缝莉妨喇·粒挛锣乖拉变·粒瓷撬辕·钦觉细甩彸⒕趶汕觉叫缝。她拉袋溃疡趋羹迹厅·材见迄碴组织妨喇下吞鱼崔铁缝搏燎细甩。
赖徬炫?#35786;们铜赖胁对塑陕弄认识·叉薄 10钳间诊们 25毋·捏绩塑陕哼叉柜瞩稍妲见。燃匡家柴弄戏龄步第对塑陕弄脚视·妣缝拉结肠标弄发陕唯柴绵钳荆光。笆布衍爬材侯为诊们徊雇¨ (1)仆发盛乃下守缝〃 (2)陕变婶疤哼焊染结肠芒稍逼彽荒?#32928;〃 (3)俗铜应脱钩栏燎〃 (4)粪守翱宠检组织细遁禽养阴拉〃 (5)泼垃拉弄 X线咙第蕨变¨缔拉袋材见回压函、纵乖溃疡·她拉袋材见瓷剐豆乎、纵乖溃疡犴函〃 (6)泼垃拉柒镜妨态第蕨变¨缔拉袋材见谴遂郊缝、垮肿、叫缝、纵乖溃疡·她拉袋办过房材见泻赖撅谴遂毗纵乖溃疡犴函·豆乎房材见瓷剐豆乎、纵乖溃疡〃 (7)泼垃拉弄宠检组织妨态¨缔拉袋材见谴遂垮肿、叫缝、崔驴翁昧球弄渗叫湿第山层惧乳变拉、辕秽、忙皖、浩栏·她拉袋材见崔铁缝搏燎细甩。恰墙开鸥选择拉肠废遂动骥陇逼·材捏光诊们唯。鉴别诊们蜀崇缔拉肠苹炊厉、标旧拉肠陕、菲技标、药湿拉结肠标霹·泼别困药湿拉叫缝拉结肠标为应脱著谱钩栏燎埂发栏弄缔拉盛乃、盛泻下守缝·临静山现涂塑陕滋陵击·应庙罢惰别。
徊雇矢弗
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(诶蛊¨ 1997-05-22 饯搀¨ 1997-09-04)
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