缺血性肠病23例临床特点分析
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摘要
研究背景:
缺血性肠病是20世纪60年代初提出的一组具有一定临床病理特点的独立性疾病,是在房颤、心肌梗死、糖尿病、高血压、结缔组织性疾病等基础上引起肠系膜动脉的栓塞或血栓形成,或低血容量、休克及药物等所致微循环灌注不足,或在近期腹部手术、肝硬化、腹腔内炎症、血黏度增高的基础上致肠系膜静脉血栓形成,以及其它原因引起肠道粘膜的急性或慢性缺血的一类疾病[1]。随着人口社会的老年化及心血管疾病和糖尿病等疾病的增加,生活习惯和膳食结构的变化,以及医技水平的提高,缺血性肠病的诊断率也日益增多。本病常混杂在基础疾病当中,诊断困难,常易误诊、漏诊,在发生肠梗死之前如何早期诊断、及时治疗、减少误诊、是挽救患者生命的关键因素。
目的:
回顾性分析缺血性肠病的临床资料,探讨其临床特点,提高对该疾病的认识和临床诊治水平,减少误诊及漏诊。
方法:
收集2006年5月~2009年12月重庆医科大学附属第一医院收治并确诊的23例缺血性肠病的临床资料,对其临床资料进行回顾性研究。并且检索重庆维普、万方数据库中1985~2005年相关缺血性肠病报道文章39篇(共700例)进行比较分析其发病情况变化趋势。
结果:
1.本组病例中,患者年龄28岁~78岁,平均57.4+16.42岁;其中男18例,女5例,男:女=3.6:1,本组病例以男性患者多见。
2.本组病例患者中合并基础疾病21例,其中既往心脑血管疾病占61.2%(13/21例)。本组病例伴便血34.8%(8/23例),腹泻17.4%(4/23例),恶心34.8%(8/23例),呕吐30.4%(7例/23例),发热26.1%(6/23例)。本组病例患者出现的腹部体征和其腹痛不相符(57.2%)。
3.本组病例血白细胞数升高39.1%(9/23例),血淀粉酶升高27.3%(3 /11例),尿淀粉酶升高14.3%(1 /7例),D-2聚体升高69.2%(9 /13例),CO-CP降低71.4%(5/7例),B超阳性90%(9/10例),肠镜阳性率50%(1/2例),胶囊内镜阳性改变33.3%(1/3例),CT阳性87.5%(7 /8例),CTV阳性100%(1/1例),CTA阳性为60%(3/5例)。
4.本组病例经内科保守好转率为39.1%(9/23例),经手术治疗好转率为52.2%(12/23例)。经综合治疗好转病例为21例,其好转率为91.3%(21/23例),总死亡率为8.7%(2/23例)。
5.缺血性肠病近二十年发病例数呈逐年升高趋势。
结论:
缺血性肠病临床症状与体征缺乏特异性,误诊率高,病死率高,早期诊断及治疗是关键。缺血性肠病近二十年发病情况呈逐年升高趋势。
Background:
Ischemic bowel disease which was proposed in the 60s of the 20th century was a group of clinical pathological diseases.It was usually companied with atrial fibrillation、myocardial infarction、diabetes、hypertension、connective tissue diseases or associated with low blood volume、shock or had the recent abdominal surgery、liver cirrhosis、peritoneal inflammation、increased blood viscosity or other reasons which could caused acute or chronic ischemia of the intestinal mucosa.
With the development of the society,the inceasing morbidity of the cardiovascular disease and diabetes,the changing of the life style and diat,the rasing of the medical technology,the morbidity of the Ischemic bowel disease was getting higher. The disease often mixed in some basic diseases which caused it difficultly to be diagnosed .So early diagnosis before intestinal infarction and treatment played an important role in saving lives of the patients.
Objective:
To analyze clinical features retrospectively and sum up experience for the diagnosis and treatment of the ischemic bowel disease,and to reduce incidence of misdiagnosis.
Methods:
Medical records of 23 patients which were diagnosed with ischemic bowel disease in the First Affiliated Hospital of Chongqing Medical University from May 2006 to December 2010 were retrospectively analyzed. And 39 articles about Ischemic bowel disease were selected from 1985~2005 to anlysize the trend of incidence during the last 20 years.
Results:
1.The patients’age range was from 28 to 78,the average age was 57.4+16.42, eighteen patients were male and five patients were female, ratio of male and female was 3.6:1.
2.91.3% of the patients combined with the basic diseases,61.2% of the patients had Cardiovascular and cerebrovascular diseases .34.8% of the patients with the symptom of hematochezia, 17.4% with diarrhea,34.8% with nausea, 30.4% with vomiting, 26.1% with fever.
3. 39.1% of the patients’laboratory examinations showed total white cell count increased, 27.3% with serum amylase increased, 14.3% with urinary amylase increased, 69.2% of with CO-CP decreased. 90% of the patients were proved by B ultrasonography , 50% of the patients were diagnosed by colonoscopy, 33.3% of the patients by Capsule Endoscopy , 87.5% by CT scan, 100% by CTV and 60% by CTA.
4. 43.5% of the patients underwent conservative therapy while 56.5% of the patients underwent a surgery, 91.3% of the patients relieved and 8.7% of the patients improved.
5.During the last 20 years,the mobidity of Ischemic bowel disease was increasing year by year.
Conclusion:
The clinical manifestation of ischemic bowel disease was less specific.The rate of misdiagnosis and mortality are high. Prognosis can be improved if it was diagnosed in time and treated as soon as possible. During the last 20 years,the mobidity of Ischemic bowel disease increased year by year.
缺血性肠病是20世纪60年代初提出的一组具有一定临床病理特点的独立性疾病,是在房颤、心肌梗死、糖尿病、高血压、结缔组织性疾病等基础上引起肠系膜动脉的栓塞或血栓形成,或低血容量、休克及药物等所致微循环灌注不足,或在近期腹部手术、肝硬化、腹腔内炎症、血黏度增高的基础上致肠系膜静脉血栓形成,以及其它原因引起肠道粘膜的急性或慢性缺血的一类疾病[1]。随着人口社会的老年化及心血管疾病和糖尿病等疾病的增加,生活习惯和膳食结构的变化,以及医技水平的提高,缺血性肠病的诊断率也日益增多。本病常混杂在基础疾病当中,诊断困难,常易误诊、漏诊,在发生肠梗死之前如何早期诊断、及时治疗、减少误诊、是挽救患者生命的关键因素。
目的:
回顾性分析缺血性肠病的临床资料,探讨其临床特点,提高对该疾病的认识和临床诊治水平,减少误诊及漏诊。
方法:
收集2006年5月~2009年12月重庆医科大学附属第一医院收治并确诊的23例缺血性肠病的临床资料,对其临床资料进行回顾性研究。并且检索重庆维普、万方数据库中1985~2005年相关缺血性肠病报道文章39篇(共700例)进行比较分析其发病情况变化趋势。
结果:
1.本组病例中,患者年龄28岁~78岁,平均57.4+16.42岁;其中男18例,女5例,男:女=3.6:1,本组病例以男性患者多见。
2.本组病例患者中合并基础疾病21例,其中既往心脑血管疾病占61.2%(13/21例)。本组病例伴便血34.8%(8/23例),腹泻17.4%(4/23例),恶心34.8%(8/23例),呕吐30.4%(7例/23例),发热26.1%(6/23例)。本组病例患者出现的腹部体征和其腹痛不相符(57.2%)。
3.本组病例血白细胞数升高39.1%(9/23例),血淀粉酶升高27.3%(3 /11例),尿淀粉酶升高14.3%(1 /7例),D-2聚体升高69.2%(9 /13例),CO-CP降低71.4%(5/7例),B超阳性90%(9/10例),肠镜阳性率50%(1/2例),胶囊内镜阳性改变33.3%(1/3例),CT阳性87.5%(7 /8例),CTV阳性100%(1/1例),CTA阳性为60%(3/5例)。
4.本组病例经内科保守好转率为39.1%(9/23例),经手术治疗好转率为52.2%(12/23例)。经综合治疗好转病例为21例,其好转率为91.3%(21/23例),总死亡率为8.7%(2/23例)。
5.缺血性肠病近二十年发病例数呈逐年升高趋势。
结论:
缺血性肠病临床症状与体征缺乏特异性,误诊率高,病死率高,早期诊断及治疗是关键。缺血性肠病近二十年发病情况呈逐年升高趋势。
Background:
Ischemic bowel disease which was proposed in the 60s of the 20th century was a group of clinical pathological diseases.It was usually companied with atrial fibrillation、myocardial infarction、diabetes、hypertension、connective tissue diseases or associated with low blood volume、shock or had the recent abdominal surgery、liver cirrhosis、peritoneal inflammation、increased blood viscosity or other reasons which could caused acute or chronic ischemia of the intestinal mucosa.
With the development of the society,the inceasing morbidity of the cardiovascular disease and diabetes,the changing of the life style and diat,the rasing of the medical technology,the morbidity of the Ischemic bowel disease was getting higher. The disease often mixed in some basic diseases which caused it difficultly to be diagnosed .So early diagnosis before intestinal infarction and treatment played an important role in saving lives of the patients.
Objective:
To analyze clinical features retrospectively and sum up experience for the diagnosis and treatment of the ischemic bowel disease,and to reduce incidence of misdiagnosis.
Methods:
Medical records of 23 patients which were diagnosed with ischemic bowel disease in the First Affiliated Hospital of Chongqing Medical University from May 2006 to December 2010 were retrospectively analyzed. And 39 articles about Ischemic bowel disease were selected from 1985~2005 to anlysize the trend of incidence during the last 20 years.
Results:
1.The patients’age range was from 28 to 78,the average age was 57.4+16.42, eighteen patients were male and five patients were female, ratio of male and female was 3.6:1.
2.91.3% of the patients combined with the basic diseases,61.2% of the patients had Cardiovascular and cerebrovascular diseases .34.8% of the patients with the symptom of hematochezia, 17.4% with diarrhea,34.8% with nausea, 30.4% with vomiting, 26.1% with fever.
3. 39.1% of the patients’laboratory examinations showed total white cell count increased, 27.3% with serum amylase increased, 14.3% with urinary amylase increased, 69.2% of with CO-CP decreased. 90% of the patients were proved by B ultrasonography , 50% of the patients were diagnosed by colonoscopy, 33.3% of the patients by Capsule Endoscopy , 87.5% by CT scan, 100% by CTV and 60% by CTA.
4. 43.5% of the patients underwent conservative therapy while 56.5% of the patients underwent a surgery, 91.3% of the patients relieved and 8.7% of the patients improved.
5.During the last 20 years,the mobidity of Ischemic bowel disease was increasing year by year.
Conclusion:
The clinical manifestation of ischemic bowel disease was less specific.The rate of misdiagnosis and mortality are high. Prognosis can be improved if it was diagnosed in time and treated as soon as possible. During the last 20 years,the mobidity of Ischemic bowel disease increased year by year.
引文
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