發(fā)布時間：2019-01-20 11:02

【摘要】：目的：分析本地區(qū)缺血性腸病的臨床特點及診療情況，以提高對缺血性腸病的認(rèn)識，明確診斷，，減少誤診率。 方法：收集2010年10月至2013年10月福建醫(yī)科大學(xué)附屬第一醫(yī)院消化內(nèi)科收治的66例缺血性腸病患者的臨床資料，回顧性分析其臨床表現(xiàn)、實驗室檢查、影像學(xué)檢查、結(jié)腸鏡檢查及治療經(jīng)過。 結(jié)果：1、66例缺血性腸病患者中缺血性結(jié)腸炎占36例（54.5%），急性腸系膜缺血次之；男女比例大致為1:1；＞60歲占74.2%；其中有59例合并基礎(chǔ)病，高血壓病68.2%，動脈硬化47.0%，還包括2型糖尿病、冠心病、高脂血癥、心房顫動、腦梗塞等疾病。2、臨床癥狀包括腹痛（93.9%）、血便（43.9%）、腹脹、便秘、腹瀉、消瘦等，其中以左腹痛（29.0%）最常見。90.6%腹部僅輕壓痛。3、56.7%糞便隱血陽性；50.0%D-二聚體檢測值升高，部分白細胞計數(shù)升高、血紅蛋白值降低、凝血酶原時間延長。4、31例患者完成螺旋CT血管造影，陽性率為61.3%，以腸系膜上動脈病變多見；而CT檢查、磁共振、全腹彩超及腹部立位平片例數(shù)較少，陽性率在16.7%-45.8%之間。5、本組中81.8%患者行結(jié)腸鏡檢查，陽性率53.7%，以累及乙狀結(jié)腸（82.8%）及降結(jié)腸和（或脾區(qū)）（51.7%）多見。有23例病理活檢，其中17例見粘膜慢性炎癥或炎性肉芽組織形成；僅少數(shù)示缺血性結(jié)腸炎改變及粘膜內(nèi)色素沉著。6、66例病例均予一般治療，且聯(lián)合改善循環(huán)55例，擴張腸道血管43例，抗凝治療33例，抗感染治療15例。64例治療有效，2例無效轉(zhuǎn)外科手術(shù)治療。 結(jié)論：缺血性腸病多見于老年人，尤其是有高血壓病和動脈硬化者，如果腹痛伴有糞便隱血、D-二聚體陽性時，應(yīng)懷疑本病。內(nèi)科治療效果良好。
[Abstract]:Objective: to analyze the clinical features and diagnosis and treatment of ischemic bowel disease in order to improve the understanding of ischemic bowel disease and to reduce the misdiagnosis rate. Methods: from October 2010 to October 2013, 66 patients with ischemic bowel disease were collected from the Department of Digestive Medicine, the first affiliated Hospital of Fujian Medical University, and their clinical manifestations, laboratory and imaging findings were analyzed retrospectively. Colonoscopy and treatment. Results: 1Ischemic colitis was found in 36 (54.5%) of 66 patients with ischemic bowel disease, followed by acute mesenteric ischemia, the ratio of male and female was about 1: 1, > 60 years old accounted for 74.2%. There were 59 cases of basic diseases, 68.2% hypertension, 47.0% arteriosclerosis, 2 type diabetes, coronary heart disease, hyperlipidemia, atrial fibrillation, cerebral infarction, etc. 2. Clinical symptoms included abdominal pain (93.9%). Blood stool (43.9%), abdominal distension, constipation, diarrhea, emaciation, etc. Left abdominal pain (29.0%) was the most common. The positive rate of spiral CT angiography was 61.3% in 41 patients with thrombin prothrombin, the positive rate was 61.3%, and the lesion of superior mesenteric artery was the most common. The positive rate of CT, magnetic resonance imaging, total abdominal color ultrasound and abdominal plain film was between 16.7- 45.8%. 81.8% of the patients underwent colonoscopy, and the positive rate was 53.7%. Sigmoid colon (82.8%), descending colon (51.7%) and descending colon (51.7%) were involved. There were 23 cases of pathological biopsy, of which 17 cases showed chronic inflammation of mucosa or inflammatory granulation tissue formation. Only a few cases showed changes of ischemic colitis and intramucosal pigmentation. 66 cases were treated with general treatment, 55 cases with combined improvement of circulation, 43 cases with dilatation of intestinal vessels, 33 cases with anticoagulant therapy, 15 cases with anti-infection treatment and 64 cases with effective treatment. 2 cases were transferred to surgery. Conclusion: ischemic bowel disease is more common in the elderly, especially in patients with hypertension and arteriosclerosis. If abdominal pain is accompanied by fecal occult blood and D-dimer is positive, the disease should be suspected. The effect of internal medicine treatment is good.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574

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